Provider Demographics
NPI:1942741558
Name:D'ANDREA, JAMIE (MS, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1958
Mailing Address - Country:US
Mailing Address - Phone:814-381-6495
Mailing Address - Fax:
Practice Address - Street 1:234 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1958
Practice Address - Country:US
Practice Address - Phone:814-381-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0064192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer