Provider Demographics
NPI:1447607098
Name:KREIS, ANDREW MARTIN (ATC, LAT, MED)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:KREIS
Suffix:
Gender:M
Credentials:ATC, LAT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 THISTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7738
Mailing Address - Country:US
Mailing Address - Phone:972-743-6003
Mailing Address - Fax:
Practice Address - Street 1:131 BARNHILL ARENA
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701
Practice Address - Country:US
Practice Address - Phone:479-200-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 6312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer