Provider Demographics
NPI:1659978351
Name:LANPHERE, ANDREW (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LANPHERE
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12131 HANFORD RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:14136-9723
Mailing Address - Country:US
Mailing Address - Phone:716-410-1384
Mailing Address - Fax:
Practice Address - Street 1:9520 FREDONIA STOCKTON RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-9518
Practice Address - Country:US
Practice Address - Phone:716-672-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002968-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer