Provider Demographics
NPI:1215277991
Name:WOOD, ANDREA ELIZABETH (MSPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELIZABETH
Last Name:WOOD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELIZABETH
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-590-4029
Mailing Address - Fax:630-590-4329
Practice Address - Street 1:317 DAKOTA DUNES BLVD
Practice Address - Street 2:STE. J
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5341
Practice Address - Country:US
Practice Address - Phone:605-540-4516
Practice Address - Fax:605-242-0020
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1193225100000X
IA004409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist