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General NPI Number Information
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NPI Number | 1275542680
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Entity Type | Individual
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Provider Name | ANDREA LYNN RAFFERTY P.T.
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Gender | Female
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4042 WERTHERS CT
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City | FAIRFAX
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State | VA
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Zip | 22030-7462
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Country | US
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Telephone | 703-691-3242
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Fax |
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Provider Business Mailing Address
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Address Line | 4042 WERTHERS CT
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City | FAIRFAX
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State | VA
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Zip | 22030-7462
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Country | US
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Telephone | 703-691-3242
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305203883
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA00878400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 022739-1
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License Number State | NY
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