Provider Demographics
NPI:1306175864
Name:GARY, ANDREA LA-SHUNN (RPTA)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LA-SHUNN
Last Name:GARY
Suffix:
Gender:F
Credentials:RPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PINE KNOLL DR STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-3281
Mailing Address - Country:US
Mailing Address - Phone:864-603-1419
Mailing Address - Fax:864-603-1414
Practice Address - Street 1:209 PINE KNOLL DR STE C
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-3281
Practice Address - Country:US
Practice Address - Phone:864-603-1419
Practice Address - Fax:864-603-1414
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-12
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite Care
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child