Provider Demographics
NPI:1831647353
Name:SHEFFERLY, ANDREA (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:SHEFFERLY
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6880 GLEN CREEK DR SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9134
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 FORT RICHARDSON AVENUE
Practice Address - Street 2:
Practice Address - City:GOODFELLOW AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:76908-4902
Practice Address - Country:US
Practice Address - Phone:354-654-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010178522251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic