Provider Demographics
NPI:1487351185
Name:EBERHARDY, ANDREA PATRICIA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PATRICIA
Last Name:EBERHARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DALY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-4702
Mailing Address - Country:US
Mailing Address - Phone:715-581-7705
Mailing Address - Fax:
Practice Address - Street 1:400 DALY AVE STE 101
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-4702
Practice Address - Country:US
Practice Address - Phone:715-424-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15306-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist