Provider Demographics
NPI:1487752945
Name:KATZ, ANDREA (DPT MA CSCS CMDT CCI)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:DPT MA CSCS CMDT CCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:2040 JOHN ROLFE PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-8111
Practice Address - Country:US
Practice Address - Phone:804-754-0916
Practice Address - Fax:804-754-0919
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010318599Medicaid
VAP00396605OtherMEDICARE RAILROAD
VA192946OtherBCBS PHYSICAL THERAPY
VA7654832OtherAETNA
VA010318599Medicaid
VA7654832OtherAETNA