Provider Demographics
NPI:1932074283
Name:ELINICH, ANDREA M (MSACN, LMT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:ELINICH
Suffix:
Gender:F
Credentials:MSACN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504-9545
Mailing Address - Country:US
Mailing Address - Phone:484-697-9304
Mailing Address - Fax:
Practice Address - Street 1:707 PINE ST
Practice Address - Street 2:
Practice Address - City:BARTO
Practice Address - State:PA
Practice Address - Zip Code:19504-9545
Practice Address - Country:US
Practice Address - Phone:484-697-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG12601225700000X
133N00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist