Provider Demographics
NPI:1306035589
Name:ANDZEL, ROBERT RICHARD (PT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RICHARD
Last Name:ANDZEL
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 1:4999 PINELEDGE DR E
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-1530
Mailing Address - Country:US
Mailing Address - Phone:716-759-0321
Mailing Address - Fax:
Practice Address - Street 1:4999 PINELEDGE DR E
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1530
Practice Address - Country:US
Practice Address - Phone:716-870-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010064-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist