Provider Demographics
NPI:1184668626
Name:FELD, ANDY J (PT)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:J
Last Name:FELD
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 1:2500 W LAYTON AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-5420
Mailing Address - Country:US
Mailing Address - Phone:414-817-5740
Mailing Address - Fax:414-817-5745
Practice Address - Street 1:2500 W LAYTON AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-5420
Practice Address - Country:US
Practice Address - Phone:414-817-5740
Practice Address - Fax:414-817-5745
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6288-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40320000Medicaid
WI40320000Medicaid