Provider Demographics
NPI:1245259266
Name:BLECKE, ANDREA E (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:BLECKE
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:P.O. BOX 1096
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-1096
Mailing Address - Country:US
Mailing Address - Phone:402-371-7407
Mailing Address - Fax:402-371-7514
Practice Address - Street 1:110 NORTH 37TH STREET
Practice Address - Street 2:UNIT 101
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701
Practice Address - Country:US
Practice Address - Phone:402-371-7407
Practice Address - Fax:402-371-7514
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2203225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist