Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305208243 | VA |
N | 2251S0007X | Physical Therapist - Sports | 2305208243 | VA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305208243 | VA |
NPI | 1548693484 |
---|---|
Provider Name | Andrew Lantz |
First Address | North Chesterfield, VA 23225-4067 |
Second Address | Virginia Beach, VA 23454-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 01/01/2019 |