Provider Demographics
NPI:1073570800
Name:CICHOSZ, ANDREW PAUL (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:CICHOSZ
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 1:2826 YARLING COURT
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4465
Mailing Address - Country:US
Mailing Address - Phone:240-463-4665
Mailing Address - Fax:
Practice Address - Street 1:402 W BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3337
Practice Address - Country:US
Practice Address - Phone:240-463-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC870572225100000X
VA2305005347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019193S57Medicare PIN