Provider Demographics
NPI:1134592876
Name:ANDREWS, JOSEPH MARK (PTA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MARK
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 NW PACIFIC WAY
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-9504
Mailing Address - Country:US
Mailing Address - Phone:541-563-7544
Mailing Address - Fax:
Practice Address - Street 1:1010 SW COAST HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-5288
Practice Address - Country:US
Practice Address - Phone:541-265-4252
Practice Address - Fax:541-265-8914
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09259225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant