Provider Demographics
NPI:1215387220
Name:ANDREWS, IAN M (PTA)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:M
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 E COLFAX AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2240
Mailing Address - Country:US
Mailing Address - Phone:321-356-1899
Mailing Address - Fax:
Practice Address - Street 1:1210 E COLFAX AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2240
Practice Address - Country:US
Practice Address - Phone:321-356-1899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13789225200000X
FL22700225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant