Provider Demographics
NPI:1447447578
Name:WALL, ANDREA NICOLE (PT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NICOLE
Last Name:WALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:6036 ROUND TOWER LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3451
Mailing Address - Country:US
Mailing Address - Phone:614-932-9445
Mailing Address - Fax:
Practice Address - Street 1:5471 SCIOTO DARBY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1310
Practice Address - Country:US
Practice Address - Phone:614-876-7356
Practice Address - Fax:614-529-7121
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH111852251G0304X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic