=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528104072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA RENEE MARLEY PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 KIELY BLVD
-----------------------------------------------------
City | SANTA CLARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-236-4545
-----------------------------------------------------
Fax | 408-236-4230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1144 PARK VIEW DR
-----------------------------------------------------
City | MILPITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-945-1007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT15765
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------