Provider Demographics
NPI:1912474792
Name:STOKES, ANDREA BAGLEY (PT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BAGLEY
Last Name:STOKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:KATHERINE
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500-1 OLD GREENVILLE HWY # 1
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631
Practice Address - Country:US
Practice Address - Phone:864-722-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist