Provider Demographics
NPI:1407835358
Name:SARNOW, ANDRE RAYMOND (RPT)
Entity Type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:RAYMOND
Last Name:SARNOW
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122
Mailing Address - Country:US
Mailing Address - Phone:970-884-2423
Mailing Address - Fax:970-884-7473
Practice Address - Street 1:182 W NORTH STREET
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-884-2423
Practice Address - Fax:970-884-7473
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSAS64288OtherBCBS
COSAS64288OtherBCBS