Provider Demographics
NPI:1851398051
Name:CIOCHETTI, ANDREA (PT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:
Last Name:CIOCHETTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 E GLENDALE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4900
Mailing Address - Country:US
Mailing Address - Phone:602-241-3145
Mailing Address - Fax:602-241-3146
Practice Address - Street 1:539 E GLENDALE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4900
Practice Address - Country:US
Practice Address - Phone:602-241-3145
Practice Address - Fax:602-241-3146
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ24998Medicare ID - Type Unspecified