Individual
MISS ANDREA JOAN HURTGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3767 DELAWARE AVE, KENMORE, NY 14217-1040
(716) 874-6175
Mailing address
6928 WALMORE RD, NIAGARA FALLS, NY 14304-3047
(716) 731-1109
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
006918-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01465154
—
NY
Enumeration date
07/31/2011
Last updated
08/13/2015
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