Provider Demographics
NPI:1356461149
Name:SUFFICOOL, ANDREW (ATC,LAT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:SUFFICOOL
Suffix:
Gender:M
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 MEADOWVIEW DR
Mailing Address - Street 2:APT 609
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5212
Mailing Address - Country:US
Mailing Address - Phone:828-262-6265
Mailing Address - Fax:
Practice Address - Street 1:135 JACK BRANCH DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28608-0001
Practice Address - Country:US
Practice Address - Phone:828-262-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer