Basic Information
| Provider Information | |||||||||
| NPI: | 1891122305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHAELSEN | ||||||||
| FirstName: | ANDREA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 625 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605238813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305751932 | ||||||||
| FaxNumber: | 6309285032 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 W WASHINGTON ST | ||||||||
| Address2: | STE 2 | ||||||||
| City: | JEFFERSON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 501291920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5153864192 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2013 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 080849 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225200000X | 01152 | IA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.