Provider Demographics
NPI:1942670369
Name:STELTER, ANDREA (MS, ATC, ATR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:STELTER
Suffix:
Gender:F
Credentials:MS, ATC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15601 FOLIAGE AVE
Mailing Address - Street 2:APT 324
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-3114
Mailing Address - Country:US
Mailing Address - Phone:214-923-5866
Mailing Address - Fax:
Practice Address - Street 1:60 MARIE AVE E
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5910
Practice Address - Country:US
Practice Address - Phone:612-266-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer