Provider Demographics
NPI:1609206622
Name:MACH, ANDREW (PTA)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:MACH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1713
Mailing Address - Country:US
Mailing Address - Phone:262-880-9561
Mailing Address - Fax:
Practice Address - Street 1:1455 HICKORY WAY
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-1713
Practice Address - Country:US
Practice Address - Phone:262-880-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2074-19208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation