Provider Demographics
NPI:1891751400
Name:KAMP, ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:KAMP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 EAST AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-2031
Mailing Address - Country:US
Mailing Address - Phone:618-258-9093
Mailing Address - Fax:618-258-9097
Practice Address - Street 1:1510 OLD ROUTE 66 NORTH
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056
Practice Address - Country:US
Practice Address - Phone:217-324-3200
Practice Address - Fax:217-324-3262
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL682316OtherBCBS
342305OtherHEALTHLINK
ILK12989Medicare ID - Type Unspecified