Provider Demographics
NPI:1013313964
Name:LALLI, ANDREW (MS, ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LALLI
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ESCONDIDO CT
Mailing Address - Street 2:
Mailing Address - City:POINCIANA
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3694
Mailing Address - Country:US
Mailing Address - Phone:203-417-5456
Mailing Address - Fax:
Practice Address - Street 1:232 ESCONDIDO CT
Practice Address - Street 2:
Practice Address - City:POINCIANA
Practice Address - State:FL
Practice Address - Zip Code:34759-3694
Practice Address - Country:US
Practice Address - Phone:203-417-5456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 33102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer