Provider Demographics
NPI:1205075405
Name:ONISHI, ANDRIA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANDRIA
Middle Name:MARIE
Last Name:ONISHI
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 1:2410 SUSANNAH ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1765
Mailing Address - Country:US
Mailing Address - Phone:423-282-9011
Mailing Address - Fax:423-722-0281
Practice Address - Street 1:2410 SUSANNAH ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-1765
Practice Address - Country:US
Practice Address - Phone:423-282-9011
Practice Address - Fax:423-722-0281
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000008267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513273Medicaid
TN1513273Medicaid
TX3646019Medicare PIN