Provider Demographics
NPI:1952532137
Name:SCHAFER, ANDREA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:NICOLE
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:11711 NE 12TH ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2461
Practice Address - Country:US
Practice Address - Phone:425-450-9474
Practice Address - Fax:425-452-0704
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60100038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952532137Medicaid
WAG8883709OtherMEDICARE PTAN NUMBER