Provider Demographics
NPI:1316142664
Name:ALBOHN, ANDREA (PTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:ALBOHN
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 1:340 AUTUMN CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-6284
Mailing Address - Country:US
Mailing Address - Phone:336-703-0083
Mailing Address - Fax:
Practice Address - Street 1:1000 SALEMTOWNE DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3294
Practice Address - Country:US
Practice Address - Phone:336-776-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant