Provider Demographics
NPI:1881789089
Name:CARVALHO, ANDREA RODRIGUES (MPT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:RODRIGUES
Last Name:CARVALHO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 JAYBIRD RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-8555
Mailing Address - Country:US
Mailing Address - Phone:214-542-3710
Mailing Address - Fax:
Practice Address - Street 1:2800 S FM 51
Practice Address - Street 2:STE B
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234
Practice Address - Country:US
Practice Address - Phone:940-627-7532
Practice Address - Fax:940-627-7547
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1169629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist