Provider Demographics
NPI:1790135655
Name:SIMICH, ANDREA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:SIMICH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 GLENDALE AVE
Mailing Address - Street 2:#12
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5775
Mailing Address - Country:US
Mailing Address - Phone:775-356-8181
Mailing Address - Fax:
Practice Address - Street 1:255 GLENDALE AVE
Practice Address - Street 2:#12
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5775
Practice Address - Country:US
Practice Address - Phone:775-356-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05063782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer