Provider Demographics
NPI:1861824237
Name:LONGLEY, ANDREW CHARLES (DPT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHARLES
Last Name:LONGLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ORCHARD VIEW DR UNIT 19A
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3336
Mailing Address - Country:US
Mailing Address - Phone:603-216-1950
Mailing Address - Fax:603-216-1950
Practice Address - Street 1:4 ORCHARD VIEW DR UNIT 19A
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3336
Practice Address - Country:US
Practice Address - Phone:603-216-1950
Practice Address - Fax:603-552-3127
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0094908225100000X
NH4213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3111799Medicaid