Provider Demographics
NPI:1861476871
Name:NOEL-DOUBLEDAY, ANDREA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:J
Last Name:NOEL-DOUBLEDAY
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:1330 QUAIL LAKE LOOP S100
Mailing Address - Street 2:PT WORKS PC CHEYENNE MOUNTAIN CLINIC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-579-0230
Mailing Address - Fax:719-579-0277
Practice Address - Street 1:5988 STETSON HILLS ROAD
Practice Address - Street 2:PT WORKS PC POWERS CLINIC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922
Practice Address - Country:US
Practice Address - Phone:719-593-1337
Practice Address - Fax:719-593-2934
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA11724225100000X
NY011702225100000X
CO89042251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
803054Medicare ID - Type Unspecified