Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PTH8724 | AL |
Y | 2251S0007X | Physical Therapist - Sports | 045799 | NY |
NPI | 1164936548 |
---|---|
Provider Name | Robert Andrews |
First Address | New York, NY 10021-4823 |
Second Address | New York, NY 10021-4823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2017 |
Last Update Date | 08/04/2021 |