Provider Demographics
NPI:1295147247
Name:LAUDERDALE, ANDREA (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LAUDERDALE
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 1:905 BURT ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-1151
Mailing Address - Country:US
Mailing Address - Phone:734-417-0852
Mailing Address - Fax:
Practice Address - Street 1:905 BURT ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-1151
Practice Address - Country:US
Practice Address - Phone:734-417-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.020620225100000X
MI5501016293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist