Provider Demographics
NPI:1649290396
Name:MCANDREW, KELLY LYNN (DPT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:MCANDREW
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 1:5781 BEECHWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3479
Mailing Address - Country:US
Mailing Address - Phone:239-910-2870
Mailing Address - Fax:
Practice Address - Street 1:1333 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2803
Practice Address - Country:US
Practice Address - Phone:239-772-7480
Practice Address - Fax:239-772-7980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0015205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist