Provider Demographics
NPI:1023047545
Name:KESSLER, ANDREA M (PT & OT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:KESSLER
Suffix:
Gender:F
Credentials:PT & OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1839
Mailing Address - Country:US
Mailing Address - Phone:412-414-5972
Mailing Address - Fax:
Practice Address - Street 1:114 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1839
Practice Address - Country:US
Practice Address - Phone:412-414-5972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC008697225X00000X
PAPT017523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001933945Medicaid