Provider Demographics
NPI:1003948381
Name:ANDRIES, KAMMAR J (DPT)
Entity Type:Individual
Prefix:DR
First Name:KAMMAR
Middle Name:J
Last Name:ANDRIES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 146TH ST
Mailing Address - Street 2:APT # 2B
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3642
Mailing Address - Country:US
Mailing Address - Phone:917-854-1902
Mailing Address - Fax:
Practice Address - Street 1:8906 146TH ST
Practice Address - Street 2:APT # 2B
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3642
Practice Address - Country:US
Practice Address - Phone:917-854-1902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22125225100000X
NY0252322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist