Provider Demographics
NPI:1992935035
Name:LATHROP, ANDREA (MSPT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LATHROP
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SIEBENALER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:7600 BURNET RD
Mailing Address - Street 2:560
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1241
Mailing Address - Country:US
Mailing Address - Phone:512-458-1183
Mailing Address - Fax:
Practice Address - Street 1:7600 BURNET RD
Practice Address - Street 2:560
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-1241
Practice Address - Country:US
Practice Address - Phone:512-458-1183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1188748225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1952415564OtherNPI
TX1952415564OtherNPI
TX00X553Medicare PIN