Provider Demographics
NPI:1518943562
Name:CLARY, ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CLARY
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 1:16621 N 91ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1524
Mailing Address - Country:US
Mailing Address - Phone:480-585-7300
Mailing Address - Fax:480-585-7740
Practice Address - Street 1:16621 N 91ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1524
Practice Address - Country:US
Practice Address - Phone:480-585-7300
Practice Address - Fax:480-585-7740
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP91142Medicare UPIN
AZ75234Medicare ID - Type Unspecified
AZZ107163Medicare PIN