Healthcare Provider Details

I. General information

NPI: 1144119165
Provider Name (Legal Business Name): ANDREA WATTIER PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA JAGELS PT

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N CUSTER AVE
GRAND ISLAND NE
68803-4304
US

IV. Provider business mailing address

PO BOX 5285
GRAND ISLAND NE
68802-5285
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-2170
  • Fax: 308-398-5232
Mailing address:
  • Phone: 308-675-1853
  • Fax: 308-210-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4817
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: