Provider Demographics
NPI:1366040594
Name:OVERSTREET, ANDREW (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:OVERSTREET
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-3239
Mailing Address - Country:US
Mailing Address - Phone:303-963-6364
Mailing Address - Fax:
Practice Address - Street 1:603 E CARLSON ST STE 304
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4443
Practice Address - Country:US
Practice Address - Phone:307-514-9999
Practice Address - Fax:307-514-6006
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0017406225100000X
WYPT2029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYPT2029OtherSTATE LICENSE