Provider Demographics
NPI:1740922988
Name:LENA, ANDREA JOHANNE MOLEN
Entity type:Individual
Prefix:
First Name:ANDREA JOHANNE
Middle Name:MOLEN
Last Name:LENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 RIVER BEND LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6658
Mailing Address - Country:US
Mailing Address - Phone:630-670-7407
Mailing Address - Fax:
Practice Address - Street 1:12450 WALKER RD
Practice Address - Street 2:
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-9301
Practice Address - Country:US
Practice Address - Phone:630-243-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070020415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist