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NPI Code Detail

MEDICARE: ANDREA DETWILER PTA

MEDICARE: ANDREA DETWILER PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantTEI006800PA

General Provider Information

NPI Number : 1093641086
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA DETWILER PTA
Provider Business Mailing Address
First Line : 236 KEYSER RIDGE RD
Second Line :
City : GRANTSVILLE
State : MD
Zip : 21536-1160
Country : US
Telephone Number : 585-317-3596
Fax Number :
Provider Business Practice Location Address
First Line : 75 HICKLE ST
Second Line :
City : UNIONTOWN
State : PA
Zip : 15401-4350
Country : US
Telephone Number : 724-437-9871
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ ANDREA DETWILER PTA” Practice Location

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