Provider Demographics
NPI:1568734408
Name:DAFLER, ANDREW JACOB (LPTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JACOB
Last Name:DAFLER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-2949
Mailing Address - Country:US
Mailing Address - Phone:937-626-8334
Mailing Address - Fax:
Practice Address - Street 1:525 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-2949
Practice Address - Country:US
Practice Address - Phone:937-626-8334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07781225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant