Provider Demographics
NPI:1124279179
Name:ANDREWS, KATHLEEN V (LMT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:V
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:O'DONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3508 NW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2142
Mailing Address - Country:US
Mailing Address - Phone:352-316-4154
Mailing Address - Fax:
Practice Address - Street 1:5127 NW 39TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-5943
Practice Address - Country:US
Practice Address - Phone:352-271-1211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 0025121225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC 8867OtherBLUE CROSS/BLUE SHIELD