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General NPI Number Information
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NPI Number | 1013069079
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Entity Type | Individual
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Provider Name | MARYBETH MCANDREW D.P.T
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5480 MARENGO AVE
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City | LA MESA
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State | CA
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Zip | 91942-2408
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Country | US
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Telephone | 617-680-0513
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Fax | 619-441-0419
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Provider Business Mailing Address
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Address Line | 3943 RIVIERA DR UNIT C
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City | SAN DIEGO
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State | CA
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Zip | 92109-5883
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Country | US
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Telephone | 617-680-0513
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Fax | 619-441-0419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 29716
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License Number State | CA
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