Provider Demographics
NPI:1447390679
Name:FREES, ANDREA M (PT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:M
Last Name:FREES
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 KEMPSVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-7320
Mailing Address - Country:US
Mailing Address - Phone:757-962-1618
Mailing Address - Fax:757-481-6175
Practice Address - Street 1:762 INDEPENDENCE BLVD
Practice Address - Street 2:#772
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6200
Practice Address - Country:US
Practice Address - Phone:757-228-5201
Practice Address - Fax:757-481-6175
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1447390679Medicaid
VA1447390679Medicaid