Healthcare Provider Details

I. General information

NPI: 1093641086
Provider Name (Legal Business Name): ANDREA DETWILER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HICKLE ST
UNIONTOWN PA
15401-4350
US

IV. Provider business mailing address

236 KEYSER RIDGE RD
GRANTSVILLE MD
21536-1160
US

V. Phone/Fax

Practice location:
  • Phone: 724-437-9871
  • Fax:
Mailing address:
  • Phone: 585-317-3596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTEI006800
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: