Provider Demographics
NPI:1427094689
Name:LEE, ANDREA MARIE (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:HARRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1422 SEMINOLE CIR
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8043
Mailing Address - Country:US
Mailing Address - Phone:205-862-1926
Mailing Address - Fax:
Practice Address - Street 1:1422 SEMINOLE CIR
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-8043
Practice Address - Country:US
Practice Address - Phone:205-862-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3542225100000X
CA21780225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51534040OtherBLUE CROSS BLUE SHEILD