Provider Demographics
NPI:1184961427
Name:WITHERSPOON, ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WITHERSPOON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 ROUTE 134
Mailing Address - Street 2:STE 5&6
Mailing Address - City:SOUTH DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660-2577
Mailing Address - Country:US
Mailing Address - Phone:508-385-4212
Mailing Address - Fax:508-385-4235
Practice Address - Street 1:860 ROUTE 134
Practice Address - Street 2:STE 5&6
Practice Address - City:SOUTH DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660-2577
Practice Address - Country:US
Practice Address - Phone:508-385-4212
Practice Address - Fax:508-385-4235
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist