=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770971749
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA REHMERT PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2014
-----------------------------------------------------
Last Update Date | 12/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3701 LOOP RD
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35404-5015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-554-2000
-----------------------------------------------------
Fax | 205-554-2028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4215 HILLSBORO DR
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35404-4445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1935
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------