Provider Demographics
NPI:1003373325
Name:ANDREOZZI, DAVID ALEXANDER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:ANDREOZZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CHERRY TREE RD APT C48
Mailing Address - Street 2:
Mailing Address - City:UPPER CHICHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19014-2464
Mailing Address - Country:US
Mailing Address - Phone:267-303-9349
Mailing Address - Fax:
Practice Address - Street 1:200 MILL RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-3718
Practice Address - Country:US
Practice Address - Phone:267-303-9349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
PART0075972255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program