Provider Demographics
NPI:1174855084
Name:WALQUIST, ANDREW SCOTT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:SCOTT
Last Name:WALQUIST
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13603 MICHEL RD
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6410
Mailing Address - Country:US
Mailing Address - Phone:281-351-7261
Mailing Address - Fax:281-378-7726
Practice Address - Street 1:13603 MICHEL RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6410
Practice Address - Country:US
Practice Address - Phone:281-351-7261
Practice Address - Fax:281-378-7726
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1195035225100000X
AZ8905PT2251P0200X
NV2395225100000X
AZ8905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ525501Medicaid