Provider Demographics
NPI:1821569534
Name:REID, ANDREW M (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:REID
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:M
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4990 HILLSDALE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 L ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4230
Practice Address - Country:US
Practice Address - Phone:916-905-6378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299471225100000X
WAPT60881070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist