Healthcare Provider Details

I. General information

NPI: 1821604273
Provider Name (Legal Business Name): MRS. ANDREA BARLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ANNA GOODE WAY
SUFFOLK VA
23434-9236
US

IV. Provider business mailing address

17541 SCOTTS FACTORY RD
SMITHFIELD VA
23430-7018
US

V. Phone/Fax

Practice location:
  • Phone: 757-923-5500
  • Fax:
Mailing address:
  • Phone: 757-696-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: