Provider Demographics
NPI:1417006719
Name:ANDRE, PHILLIP HOWARD (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:HOWARD
Last Name:ANDRE
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1104 N FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3203
Mailing Address - Country:US
Mailing Address - Phone:517-974-2725
Mailing Address - Fax:269-749-4144
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OLIVET
Practice Address - State:MI
Practice Address - Zip Code:49076-9406
Practice Address - Country:US
Practice Address - Phone:269-749-4167
Practice Address - Fax:269-749-4144
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer