Provider Demographics
NPI:1801052352
Name:RECTOR, ANDREA D (DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:D
Last Name:RECTOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:D
Other - Last Name:RICKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2215
Mailing Address - Country:US
Mailing Address - Phone:785-843-9125
Mailing Address - Fax:785-843-6973
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2215
Practice Address - Country:US
Practice Address - Phone:785-843-9125
Practice Address - Fax:785-843-6973
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200597290AMedicaid