Provider Demographics
NPI:1457828634
Name:SLABY, ANDREW HUNTER (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:HUNTER
Last Name:SLABY
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 1:13901 REFLECTION CT APT 519
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-8031
Mailing Address - Country:US
Mailing Address - Phone:517-260-4505
Mailing Address - Fax:
Practice Address - Street 1:800 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2133
Practice Address - Country:US
Practice Address - Phone:314-522-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028671225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant