Provider Demographics
NPI:1043228521
Name:EMERY, ANDREW J (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:EMERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:NEWPORT CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05857
Mailing Address - Country:US
Mailing Address - Phone:802-334-8882
Mailing Address - Fax:802-334-8868
Practice Address - Street 1:2542 VT RTE 105
Practice Address - Street 2:
Practice Address - City:NEWPORT CENTER
Practice Address - State:VT
Practice Address - Zip Code:05857
Practice Address - Country:US
Practice Address - Phone:802-334-8882
Practice Address - Fax:802-334-8868
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003605225100000X
NVPT1904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPT1904OtherPHYSICAL THERAPY LICENSE