Provider Demographics
NPI:1841757911
Name:FRITZ, ANDREW W (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:FRITZ
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 COURT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-1784
Mailing Address - Country:US
Mailing Address - Phone:641-541-0168
Mailing Address - Fax:
Practice Address - Street 1:700 COLLEGE DRIVE
Practice Address - Street 2:REGENTS CENTER
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101
Practice Address - Country:US
Practice Address - Phone:641-541-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0935942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA093594OtherSTATE OF IOWA BOARD OF ATHLETIC TRAINING