Provider Demographics
NPI:1639191919
Name:SEO, ANDREW Y (PT)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:Y
Last Name:SEO
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 1:100 CHETWYND DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1453
Mailing Address - Country:US
Mailing Address - Phone:610-822-1072
Mailing Address - Fax:
Practice Address - Street 1:100 CHETWYND DR STE 103
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1453
Practice Address - Country:US
Practice Address - Phone:610-822-1072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA233224QHHMedicare PIN