Provider Demographics
NPI:1861816084
Name:CORDEIRO, ANDREA (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CORDEIRO
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:KNOCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:ULM
Mailing Address - State:MT
Mailing Address - Zip Code:59485-0108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 ULM VAUGHN ROAD
Practice Address - Street 2:
Practice Address - City:ULM
Practice Address - State:MT
Practice Address - Zip Code:59485
Practice Address - Country:US
Practice Address - Phone:406-788-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTATR-LAT-LIC-20174400000X
MTLMT-LMT-LIC-1017174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist