Provider Demographics
NPI:1215170428
Name:TATE, ANDREA A (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:A
Last Name:TATE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77353-0426
Mailing Address - Country:US
Mailing Address - Phone:281-252-2550
Mailing Address - Fax:281-252-2563
Practice Address - Street 1:42202 FM 1774
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77353-4204
Practice Address - Country:US
Practice Address - Phone:281-252-2550
Practice Address - Fax:281-252-2563
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT32932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer