Provider Demographics
NPI:1659684785
Name:FLYNN, ANDREW MARTIN (PTA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARTIN
Last Name:FLYNN
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 1:1107 COUNTRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-4657
Mailing Address - Country:US
Mailing Address - Phone:717-525-7287
Mailing Address - Fax:
Practice Address - Street 1:1107 COUNTRY HILL DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-4657
Practice Address - Country:US
Practice Address - Phone:717-525-7287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE008650225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant