Provider Demographics
NPI:1306192596
Name:SLEGEL, ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:SLEGEL
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 1:25 S HOME AVE
Mailing Address - Street 2:
Mailing Address - City:TOPTON
Mailing Address - State:PA
Mailing Address - Zip Code:19562-1223
Mailing Address - Country:US
Mailing Address - Phone:717-586-7821
Mailing Address - Fax:
Practice Address - Street 1:128 S CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5733
Practice Address - Country:US
Practice Address - Phone:575-628-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist