MEDICARE: VANDA ANDELOVA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT 20918	FL
2	225100000X	Physical Therapist	LPT-32686	AZ

General Provider Information

NPI Number	:	1821087107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANDA ANDELOVA PT

Provider Business Mailing Address
First Line	:	PO BOX 80217
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85060-0217
Country	:	US
Telephone Number	:	602-385-2115
Fax Number	:	480-418-3323

Provider Business Practice Location Address
First Line	:	10450 W MCDOWELL RD STE 102
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-4901
Country	:	US
Telephone Number	:	602-648-5444
Fax Number	:	602-772-3801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	11/14/2022

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Directions to “ VANDA ANDELOVA PT” Practice Location

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