MEDICARE: MS. KELLY LYNN MCANDREW DPT

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	PT0015205	FL

General Provider Information

NPI Number	:	1649290396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY LYNN MCANDREW DPT

Provider Business Mailing Address
First Line	:	5781 BEECHWOOD TRL
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3479
Country	:	US
Telephone Number	:	239-910-2870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 SANTA BARBARA BLVD
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-2803
Country	:	US
Telephone Number	:	239-772-7480
Fax Number	:	239-772-7980

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/08/2007

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