Provider Demographics
NPI:1396024782
Name:HERMANN, ANDREW (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:HERMANN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LONGMIRE DR
Mailing Address - Street 2:APT. 42
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5832
Mailing Address - Country:US
Mailing Address - Phone:979-695-9016
Mailing Address - Fax:
Practice Address - Street 1:2800 LONGMIRE DR
Practice Address - Street 2:APT. 42
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5832
Practice Address - Country:US
Practice Address - Phone:979-695-9016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2082522225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant