Provider Demographics
NPI:1558350983
Name:GILL, ANDREW GRANT (ATC)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:GRANT
Last Name:GILL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18229 REGINA AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-4609
Mailing Address - Country:US
Mailing Address - Phone:310-703-4549
Mailing Address - Fax:
Practice Address - Street 1:5772 BOLSA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1134
Practice Address - Country:US
Practice Address - Phone:714-897-3589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer