Provider Demographics
NPI:1336182658
Name:MCDONNELL, ANDREW D (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:MCDONNELL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 HIGHWAY 35 NORTH
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382
Mailing Address - Country:US
Mailing Address - Phone:361-727-1925
Mailing Address - Fax:361-727-9257
Practice Address - Street 1:2207 HIGHWAY 35 NORTH
Practice Address - Street 2:SUITE A
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382
Practice Address - Country:US
Practice Address - Phone:361-727-1925
Practice Address - Fax:361-727-9257
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1124766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89782TOtherBCBS
676527Medicare ID - Type Unspecified