Provider Demographics
NPI:1821497553
Name:ANDOLINA, GIOVANNI I
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:ANDOLINA
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:GIOVANNI
Other - Middle Name:
Other - Last Name:ANDOLINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1400 SOUTH 320TH STREET
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-735-0316
Mailing Address - Fax:
Practice Address - Street 1:1400 S 320TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5374
Practice Address - Country:US
Practice Address - Phone:253-735-0316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1 60032153225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant