Provider Demographics
NPI:1255100566
Name:PLUMMER, ANDREA (PTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PLUMMER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MAR HILL ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-2785
Mailing Address - Country:US
Mailing Address - Phone:151-257-3671
Mailing Address - Fax:
Practice Address - Street 1:4701 RATCLIFFE DR APT 117
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6437
Practice Address - Country:US
Practice Address - Phone:512-920-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant