Healthcare Provider Details

I. General information

NPI: 1649461336
Provider Name (Legal Business Name): ANDREA ELIZABETH AFRICA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 LEE HWY
ARLINGTON VA
22207-3721
US

IV. Provider business mailing address

681 BEVILLE BLVD
SOUTH DAYTONA FL
32119
US

V. Phone/Fax

Practice location:
  • Phone: 703-243-7640
  • Fax:
Mailing address:
  • Phone: 800-330-7711
  • Fax: 866-426-2811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2306602328
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTE007448
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: