Provider Demographics
NPI:1700836004
Name:ANDRE, JOHANNE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHANNE
Middle Name:
Last Name:ANDRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7280 HILLSIDE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:W HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-2375
Mailing Address - Country:US
Mailing Address - Phone:747-272-4704
Mailing Address - Fax:
Practice Address - Street 1:7280 HILLSIDE AVE
Practice Address - Street 2:#201
Practice Address - City:W HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-2375
Practice Address - Country:US
Practice Address - Phone:747-272-4704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7174ZMedicare PIN