Provider Demographics
NPI:1831761212
Name:HURNDON, ANDREA SYMONE (MEDICAL MASSAGE)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SYMONE
Last Name:HURNDON
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 W PIONEER DR APT 2097
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-8131
Mailing Address - Country:US
Mailing Address - Phone:469-396-1795
Mailing Address - Fax:
Practice Address - Street 1:4254 W PIONEER DR APT 2097
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-8131
Practice Address - Country:US
Practice Address - Phone:469-396-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist