Provider Demographics
NPI:1023067006
Name:ANDELIN, JAMES MICHAEL (MSPT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:ANDELIN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2570 GLENRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-5954
Mailing Address - Country:US
Mailing Address - Phone:804-598-9356
Mailing Address - Fax:
Practice Address - Street 1:12882 PATRICK HENRY HWY
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:VA
Practice Address - Zip Code:23002-3929
Practice Address - Country:US
Practice Address - Phone:804-561-1617
Practice Address - Fax:804-561-1618
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305006053225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist