Provider Demographics
NPI:1356732002
Name:LEGG, ANDREA KAY (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:KAY
Last Name:LEGG
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SEQUOIA DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5156
Mailing Address - Country:US
Mailing Address - Phone:505-249-6925
Mailing Address - Fax:
Practice Address - Street 1:4401 S CZECH HALL RD
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-9571
Practice Address - Country:US
Practice Address - Phone:505-249-6925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT46862255A2300X
OKAT6802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer