Provider Demographics
NPI:1669660767
Name:TIGNOR, ANDREA OTTALEE (PT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:OTTALEE
Last Name:TIGNOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PROFESSIONAL VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1570
Mailing Address - Country:US
Mailing Address - Phone:843-986-9670
Mailing Address - Fax:843-986-9369
Practice Address - Street 1:18 PROFESSIONAL VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1570
Practice Address - Country:US
Practice Address - Phone:843-986-9670
Practice Address - Fax:843-986-9369
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT3799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist