Provider Demographics
NPI:1841555265
Name:CARRELL, ANDREW D (DPT)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:D
Last Name:CARRELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 NW DAWN DR
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1093
Mailing Address - Country:US
Mailing Address - Phone:541-314-2406
Mailing Address - Fax:
Practice Address - Street 1:6825 BURDEN BLVD STE D
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301
Practice Address - Country:US
Practice Address - Phone:509-416-0444
Practice Address - Fax:509-545-1112
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06902225100000X
WAPT60615361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist