MEDICARE: ED ANDREE MPT

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
1	225100000X	Physical Therapist	5216	OR

General Provider Information

NPI Number	:	1093808560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ED ANDREE MPT

Provider Business Mailing Address
First Line	:	2847 PROSPECT AVE
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1060
Country	:	US
Telephone Number	:	815-757-6247
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 PROSPECT AVE
Second Line	:
City	:	HOOD RIVER
State	:	OR
Zip	:	97031-1060
Country	:	US
Telephone Number	:	815-757-6247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/19/2016

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Directions to “ ED ANDREE MPT” Practice Location

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