Provider Demographics
NPI:1588119085
Name:ANDREWS, ANGELA ROSE (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:ROSE
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:ROSE
Other - Last Name:WUNDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1155 13TH ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91932-3608
Mailing Address - Country:US
Mailing Address - Phone:503-453-4841
Mailing Address - Fax:858-755-5201
Practice Address - Street 1:1155 13TH ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932-3608
Practice Address - Country:US
Practice Address - Phone:503-453-4841
Practice Address - Fax:858-755-5201
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist