Provider Demographics
NPI:1669015277
Name:SPANGLER, ANDREW JEFFREY
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JEFFREY
Last Name:SPANGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 VERMILION DR
Mailing Address - Street 2:
Mailing Address - City:PARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28371-8447
Mailing Address - Country:US
Mailing Address - Phone:910-705-1051
Mailing Address - Fax:
Practice Address - Street 1:2106 HOPE MILLS RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4226
Practice Address - Country:US
Practice Address - Phone:910-705-1051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-26
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist