Basic Information
| Provider Information | |||||||||
| NPI: | 1699750083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | MRAZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 CORPORATE WOODS DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509126840 | ||||||||
| FaxNumber: | 8509126843 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 CORPORATE WOODS DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8509126840 | ||||||||
| FaxNumber: | 8509126843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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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 | 16658 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.