Provider Demographics
NPI:1922277151
Name:HASTON, ANDREA LYNNAE (DPT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:LYNNAE
Last Name:HASTON
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12465 LEWIS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-4681
Mailing Address - Country:US
Mailing Address - Phone:714-703-8477
Mailing Address - Fax:714-703-8157
Practice Address - Street 1:12465 LEWIS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-4681
Practice Address - Country:US
Practice Address - Phone:714-703-8477
Practice Address - Fax:714-703-8157
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist