Provider Demographics
NPI:1881859916
Name:BERRY, ANDREA MEGAN (LMP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MEGAN
Last Name:BERRY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 NW WINDUS ST
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-3153
Mailing Address - Country:US
Mailing Address - Phone:509-332-8771
Mailing Address - Fax:509-332-8771
Practice Address - Street 1:102 W MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-2826
Practice Address - Country:US
Practice Address - Phone:509-332-8771
Practice Address - Fax:509-332-8771
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA22613225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist