MEDICARE: MS. ANDREA LYNN HARNEY 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
1	225200000X	Physical Therapy Assistant	914	NE

General Provider Information

NPI Number	:	1871895698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA LYNN HARNEY PTA

Provider Business Mailing Address
First Line	:	1220 W BENJAMIN AVE STE 4
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 W BENJAMIN AVE STE 4
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-2769
Country	:	US
Telephone Number	:	402-371-9707
Fax Number	:

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	03/07/2012

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