Individual
MRS. ANDREA LORENE IDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1200 DRIVING PARK AVE, NEWARK, NY 14513-1090
(315) 332-2289
(315) 332-2472
Mailing address
PO BOX 111, NEWARK, NY 14513-0111
(315) 332-2289
(315) 332-2472
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
024986-1
NY
Other
Enumeration date
12/05/2019
Last updated
12/05/2019
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