Provider Demographics
NPI:1750788147
Name:CORDLE, ANDREA (PT, ATC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CORDLE
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 MARKET ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6533
Mailing Address - Country:US
Mailing Address - Phone:803-547-9800
Mailing Address - Fax:803-547-9804
Practice Address - Street 1:CAROLINA SPORTS CLINIC
Practice Address - Street 2:985 MARKET STREET SUITE 201
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6443
Practice Address - Country:US
Practice Address - Phone:803-547-9800
Practice Address - Fax:803-547-9804
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11528225100000X
NCLAT-17482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer