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General NPI Number Information
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NPI Number | 1093641086
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Entity Type | Individual
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Provider Name | ANDREA DETWILER PTA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 75 HICKLE ST
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City | UNIONTOWN
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State | PA
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Zip | 15401-4350
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Country | US
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Telephone | 724-437-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 236 KEYSER RIDGE RD
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City | GRANTSVILLE
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State | MD
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Zip | 21536-1160
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Country | US
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Telephone | 585-317-3596
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI006800
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License Number State | PA
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