Provider Demographics
NPI:1013069079
Name:MCANDREW, MARYBETH (DPT)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MCANDREW
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 RIVIERA DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-5883
Mailing Address - Country:US
Mailing Address - Phone:617-680-0513
Mailing Address - Fax:619-441-0419
Practice Address - Street 1:5480 MARENGO AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2408
Practice Address - Country:US
Practice Address - Phone:617-680-0513
Practice Address - Fax:619-441-0419
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29716225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist