Provider Demographics
NPI:1881925253
Name:FISHLOCK, ANDREA MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:FISHLOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:WEIDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1311 ROUTE 100
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BARTO
Mailing Address - State:PA
Mailing Address - Zip Code:19504-8724
Mailing Address - Country:US
Mailing Address - Phone:610-845-5000
Mailing Address - Fax:610-845-5011
Practice Address - Street 1:1311 ROUTE 100
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BARTO
Practice Address - State:PA
Practice Address - Zip Code:19504-8724
Practice Address - Country:US
Practice Address - Phone:610-845-5000
Practice Address - Fax:610-845-5011
Is Sole Proprietor?:No
Enumeration Date:2010-01-24
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007363L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist