Provider Demographics
NPI:1962861682
Name:SPRAGUE, ANDREW LYNN (PT, PHD, DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:LYNN
Last Name:SPRAGUE
Suffix:
Gender:M
Credentials:PT, PHD, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TECHNOLOGY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-3138
Mailing Address - Country:US
Mailing Address - Phone:412-383-6632
Mailing Address - Fax:
Practice Address - Street 1:100 TECHNOLOGY DR STE 210
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-3138
Practice Address - Country:US
Practice Address - Phone:412-383-6632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT029148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist