Provider Demographics
NPI:1477959443
Name:TRAN, ANDY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 S FLORIDA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1151
Mailing Address - Country:US
Mailing Address - Phone:863-647-3665
Mailing Address - Fax:863-647-2998
Practice Address - Street 1:3900 S FLORIDA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1151
Practice Address - Country:US
Practice Address - Phone:863-647-3665
Practice Address - Fax:863-647-2998
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist