Provider Demographics
NPI:1558579003
Name:HUMPHREY, ANDREW PATRICK (RPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:PATRICK
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 NE HUNTERS CT
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1842
Mailing Address - Country:US
Mailing Address - Phone:816-210-4575
Mailing Address - Fax:
Practice Address - Street 1:5130 WOODSON RD
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-3065
Practice Address - Country:US
Practice Address - Phone:816-737-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist