Provider Demographics
NPI:1154034130
Name:TADROSS, ANDREA (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:TADROSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 N ROXBORO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1888
Mailing Address - Country:US
Mailing Address - Phone:919-479-9001
Mailing Address - Fax:919-479-9003
Practice Address - Street 1:4214 N ROXBORO ST STE 100
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1888
Practice Address - Country:US
Practice Address - Phone:919-479-9001
Practice Address - Fax:919-479-9003
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist