Provider Demographics
NPI:1134555147
Name:BIR, ANDREW STEPHEN (PTA)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:STEPHEN
Last Name:BIR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:930 ELIJAH WAY
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-3429
Mailing Address - Country:US
Mailing Address - Phone:706-575-5733
Mailing Address - Fax:
Practice Address - Street 1:300 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8531
Practice Address - Country:US
Practice Address - Phone:802-658-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0134004PROV225200000X
TNCP010737A225200000X
VACP018387A225200000X
GAPTA003128225200000X
SC4867225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant