Provider Demographics
NPI:1457383580
Name:ANDREW, JOHN A (DPT, MPT, CSCS)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:ANDREW
Suffix:
Gender:M
Credentials:DPT, MPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 NE BAKER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2656
Mailing Address - Country:US
Mailing Address - Phone:503-435-1900
Mailing Address - Fax:503-435-1930
Practice Address - Street 1:2025 NE BAKER ST
Practice Address - Street 2:SUITE A
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2656
Practice Address - Country:US
Practice Address - Phone:503-435-1900
Practice Address - Fax:877-540-6659
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3629225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142491Medicare PIN