Provider Demographics
NPI:1265405609
Name:LAIR, ANDREW G (PT, ATC, MED)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:G
Last Name:LAIR
Suffix:
Gender:M
Credentials:PT, ATC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 KENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-6811
Mailing Address - Country:US
Mailing Address - Phone:513-792-0777
Mailing Address - Fax:513-792-0061
Practice Address - Street 1:9419 KENWOOD RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-6811
Practice Address - Country:US
Practice Address - Phone:513-792-0777
Practice Address - Fax:513-792-0061
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT05171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00611846OtherRR MEDICARE PTAN
OH000000178624OtherANTHEM PIN
OHP00611846OtherRR MEDICARE PTAN
OH000000178624OtherANTHEM PIN