Basic Information
| Provider Information | |||||||||
| NPI: | 1821087107 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDELOVA | ||||||||
| FirstName: | VANDA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3903 NORTHDALE BLVD | ||||||||
| Address2: | STE 111W | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336241853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133816778 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21756 STATE ROAD 54 | ||||||||
| Address2: | STE 102 | ||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335492905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139789700 | ||||||||
| FaxNumber: | 8139725055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | PT 20918 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.