Provider Demographics
NPI:1518332972
Name:ATKINS, ANDREW WILLIAM (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:WILLIAM
Last Name:ATKINS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29645 RANCHO CALIFORNIA RD
Mailing Address - Street 2:STE. 234
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-6200
Mailing Address - Country:US
Mailing Address - Phone:951-506-3001
Mailing Address - Fax:951-506-3002
Practice Address - Street 1:31515 RANCHO PUEBLO RD
Practice Address - Street 2:STE. 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4836
Practice Address - Country:US
Practice Address - Phone:951-303-1414
Practice Address - Fax:951-303-1616
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA180205Medicare PIN
CACB246980Medicare PIN
CACA180207Medicare PIN
CACA180206Medicare PIN