Provider Demographics
NPI:1124322854
Name:THURMAN, ANDREA MERCEDES (PTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MERCEDES
Last Name:THURMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 CHAPEL TREE CIR APT H
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-9305
Mailing Address - Country:US
Mailing Address - Phone:352-789-0711
Mailing Address - Fax:
Practice Address - Street 1:1708 CHAPEL TREE CIR APT H
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-9305
Practice Address - Country:US
Practice Address - Phone:352-789-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22742225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant