Provider Demographics
NPI:1487195061
Name:PATANGAN, ANDREY GUINCHOMA
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:GUINCHOMA
Last Name:PATANGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 W SAMPLE RD APT 304
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3268
Mailing Address - Country:US
Mailing Address - Phone:954-242-8016
Mailing Address - Fax:
Practice Address - Street 1:5900 W SAMPLE RD APT 304
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3268
Practice Address - Country:US
Practice Address - Phone:954-242-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33488225100000X
DEJ1-0003646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist