Provider Demographics
NPI:1336560960
Name:ANDREW, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:ANDREW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3769 5 WAKAGURI, AMI MACHI
Mailing Address - Street 2:
Mailing Address - City:INASHIKI GUN
Mailing Address - State:IBARAKI KEN
Mailing Address - Zip Code:300 0333
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3769 5 WAKAGURI, AMI MACHI
Practice Address - Street 2:
Practice Address - City:INASHIKI GUN
Practice Address - State:IBARAKI KEN
Practice Address - Zip Code:300 0333
Practice Address - Country:JP
Practice Address - Phone:81804-922-4569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist