Provider Demographics
NPI:1952900607
Name:AMING, ANDREA LISSETTE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:LISSETTE
Last Name:AMING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4914
Mailing Address - Country:US
Mailing Address - Phone:832-674-5918
Mailing Address - Fax:
Practice Address - Street 1:2712 BEE CAVES RD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5662
Practice Address - Country:US
Practice Address - Phone:512-732-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist