Provider Demographics
NPI:1972551125
Name:EVANS, ANDREA L (PT DPT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 COUNTY HIGHWAY 142A
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-3725
Mailing Address - Country:US
Mailing Address - Phone:518-774-5362
Mailing Address - Fax:
Practice Address - Street 1:5010 STATE HIGHWAY 30 STE G03
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-7532
Practice Address - Country:US
Practice Address - Phone:518-841-3406
Practice Address - Fax:518-841-3405
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019751-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02302376Medicaid
NYDD3372Medicare ID - Type Unspecified