Provider Demographics
NPI:1659782027
Name:STAPLETON, ANDREW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STAPLETON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8572 SNOWSHOE TRL
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8875
Mailing Address - Country:US
Mailing Address - Phone:315-317-0489
Mailing Address - Fax:
Practice Address - Street 1:36029 58TH STREET
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-287-7281
Practice Address - Fax:254-287-7980
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist