Provider Demographics
NPI:1982635686
Name:TEMPLES, ANDRA KAY (PT)
Entity Type:Individual
Prefix:
First Name:ANDRA
Middle Name:KAY
Last Name:TEMPLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 MAGNOLIA BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-6394
Mailing Address - Country:US
Mailing Address - Phone:850-482-4850
Mailing Address - Fax:
Practice Address - Street 1:4966 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-6814
Practice Address - Country:US
Practice Address - Phone:850-526-4766
Practice Address - Fax:850-526-4866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886499300Medicaid
FL886499300Medicaid