Basic Information
| Provider Information | |||||||||
| NPI: | 1477784130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4220 132ND ST SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MILL CREEK | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980128999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 2701 171ST PL NE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | MARYSVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982714739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603867401 | ||||||||
| FaxNumber: | 3603867402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2009 | ||||||||
| LastUpdateDate: | 10/01/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2305206090 | VA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0301162 | 01 | WA | L & I | OTHER | 0301169 | 01 | WA | L & I | OTHER | 0301209 | 01 | WA | L & I | OTHER | 0301158 | 01 | WA | L & I | OTHER | 0328504 | 01 | WA | L & I | OTHER |