Provider Demographics
NPI:1780828426
Name:MCCRORY, ANDREA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:
Last Name:MCCRORY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:V
Other - Last Name:BANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1340 TUSKAWILLA RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5030
Mailing Address - Country:US
Mailing Address - Phone:407-461-8408
Mailing Address - Fax:
Practice Address - Street 1:1340 TUSKAWILLA RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5030
Practice Address - Country:US
Practice Address - Phone:407-461-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA26813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist