Provider Demographics
NPI:1356728638
Name:BLIZ, ANDREW R (ATC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:R
Last Name:BLIZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20C ALUMNI ARENA
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14260-5001
Mailing Address - Country:US
Mailing Address - Phone:716-645-8792
Mailing Address - Fax:716-645-3085
Practice Address - Street 1:20C ALUMNI ARENA
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14260-5001
Practice Address - Country:US
Practice Address - Phone:716-645-8792
Practice Address - Fax:716-645-3085
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002626-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer