Provider Demographics
NPI:1427059906
Name:YANNELLI-CLARK, ANDREA M (PT)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:M
Last Name:YANNELLI-CLARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:M
Other - Last Name:YANNELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1270 BROADCASTING RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3203
Mailing Address - Country:US
Mailing Address - Phone:610-372-1586
Mailing Address - Fax:610-372-1589
Practice Address - Street 1:1270 BROADCASTING RD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3203
Practice Address - Country:US
Practice Address - Phone:610-372-1586
Practice Address - Fax:610-372-1589
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002842E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA643454OtherBLUE SHIELD
PA50071312OtherBLUE CROSS