Provider Demographics
NPI:1821332982
Name:PITRE, ANDREW (PT,DPT, OTR/L)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PITRE
Suffix:
Gender:M
Credentials:PT,DPT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SUMMER BREEZE WAY APT 2105
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-1804
Mailing Address - Country:US
Mailing Address - Phone:337-739-1032
Mailing Address - Fax:
Practice Address - Street 1:150 MARINER HEALTH WAY
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3215
Practice Address - Country:US
Practice Address - Phone:904-797-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28829225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist