Provider Demographics
NPI:1023651866
Name:NADEAU, ANDREW JOHN (ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:NADEAU
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 PARK ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5118
Mailing Address - Country:US
Mailing Address - Phone:802-274-7179
Mailing Address - Fax:
Practice Address - Street 1:192 PARK ST UNIT 1
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5118
Practice Address - Country:US
Practice Address - Phone:802-274-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104.01339452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer