Provider Demographics
NPI:1790249258
Name:GEDDIS, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GEDDIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 REAGAN RD
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01034-9706
Mailing Address - Country:US
Mailing Address - Phone:413-218-8459
Mailing Address - Fax:
Practice Address - Street 1:164 REAGAN RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:MA
Practice Address - Zip Code:01034-9706
Practice Address - Country:US
Practice Address - Phone:413-218-8459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9587225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant