Provider Demographics
NPI:1821144965
Name:HUTSON, ANDREA JOY (MSPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JOY
Last Name:HUTSON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 CORBIN CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-1895
Mailing Address - Country:US
Mailing Address - Phone:606-526-2909
Mailing Address - Fax:606-526-2901
Practice Address - Street 1:105 S. LIBERTY STREET
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1437
Practice Address - Country:US
Practice Address - Phone:606-546-4112
Practice Address - Fax:606-546-8456
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11443225100000X
KY004429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0961204Medicare ID - Type Unspecified