Provider Demographics
NPI:1891044509
Name:POWELL, ANDREA RENEE (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:POWELL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:1202 N CHARLES G SEIVERS BLVD
Practice Address - Street 2:STE A
Practice Address - City:CLINTON
Practice Address - State:TN
Practice Address - Zip Code:37716-3936
Practice Address - Country:US
Practice Address - Phone:865-457-0192
Practice Address - Fax:865-457-2284
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant