Provider Demographics
NPI:1609095058
Name:RAFTERY, ANDREA RUTH (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RUTH
Last Name:RAFTERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 VIA CALLEJON STE B
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6264
Mailing Address - Country:US
Mailing Address - Phone:949-498-5100
Mailing Address - Fax:949-366-5665
Practice Address - Street 1:1120 VIA CALLEJON
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6213
Practice Address - Country:US
Practice Address - Phone:949-498-5100
Practice Address - Fax:949-366-5665
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280072251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics