MEDICARE: MS. ANDREA OTTALEE TIGNOR PT

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	PT3799	TN

General Provider Information

NPI Number	:	1669660767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA OTTALEE TIGNOR PT

Provider Business Mailing Address
First Line	:	18 PROFESSIONAL VILLAGE CIR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-1570
Country	:	US
Telephone Number	:	843-986-9670
Fax Number	:	843-986-9369

Provider Business Practice Location Address
First Line	:	18 PROFESSIONAL VILLAGE CIR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-1570
Country	:	US
Telephone Number	:	843-986-9670
Fax Number	:	843-986-9369

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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