Provider Demographics
NPI:1275502965
Name:TEMOSHENKA, ANDREW ALLEN (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALLEN
Last Name:TEMOSHENKA
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 GRAND BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-1955
Mailing Address - Country:US
Mailing Address - Phone:724-684-6000
Mailing Address - Fax:724-684-6010
Practice Address - Street 1:1295 GRAND BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1955
Practice Address - Country:US
Practice Address - Phone:724-684-6000
Practice Address - Fax:724-684-6010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008316-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1633321Medicaid
PA753508OtherKEYSTONE HEALTHPLAN WEST
PA753508Medicare ID - Type Unspecified
S40151Medicare UPIN