Active NPI
Andrea Lauderdale, DPT
- Physical Therapist
- Tecumseh, MI
National Provider Identifier
1295147247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501016293
- Practice address
- 905 Burt St
Tecumseh, MI 49286-1151 - Phone
- (734) 417-0852
- NPI assigned
- May 27, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.020620 | IL | |
| Physical Therapist | 225100000X | 5501016293 | MI | Primary |
Addresses
Primary practice location
905 Burt St
Tecumseh, MI 49286-1151
Mailing address
905 Burt St
Tecumseh, MI 49286-1151
Phone (734) 417-0852
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.020620 | IL | MD | Physical Therapist |
| 5501016293 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714953600000",
"number": "1295147247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 BURT ST",
"city": "TECUMSEH",
"state": "MI",
"postal_code": "492861151",
"telephone_number": "734-417-0852"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 BURT ST",
"city": "TECUMSEH",
"state": "MI",
"postal_code": "492861151",
"telephone_number": "734-417-0852"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAUDERDALE",
"first_name": "ANDREA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-27",
"last_updated": "2024-05-06",
"certification_date": "2024-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.020620",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501016293",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tecumseh, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.