Provider Demographics
NPI:1043684194
Name:ITURRALDE, ANDREA (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ITURRALDE
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 1:92B LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-3448
Mailing Address - Country:US
Mailing Address - Phone:908-967-4202
Mailing Address - Fax:
Practice Address - Street 1:2170 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5704
Practice Address - Country:US
Practice Address - Phone:828-490-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-30
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5068225100000X
NCP17615225100000X
OR61190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist