Provider Demographics
NPI:1710217617
Name:MOHR, ANDREW J (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:MOHR
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 1:1201 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2306
Mailing Address - Country:US
Mailing Address - Phone:661-327-4357
Mailing Address - Fax:661-327-1758
Practice Address - Street 1:1201 23RD ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2306
Practice Address - Country:US
Practice Address - Phone:661-327-4357
Practice Address - Fax:661-327-1758
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ21296ZOtherMEDICARE GROUP PTAN
CACS611ZOtherMEDICARE PTAN