Provider Demographics
NPI:1861035552
Name:ESENWEIN, ANDREA C (LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:C
Last Name:ESENWEIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4228
Mailing Address - Country:US
Mailing Address - Phone:330-289-4964
Mailing Address - Fax:
Practice Address - Street 1:1485 STATE ROUTE 44
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:OH
Practice Address - Zip Code:44201-9267
Practice Address - Country:US
Practice Address - Phone:330-325-7390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.023898225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist