Provider Demographics
NPI:1457593212
Name:BLEVINS, ANDREW KYLE (MPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:KYLE
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 FM 2100 RD
Mailing Address - Street 2:SUITE4
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-9161
Mailing Address - Country:US
Mailing Address - Phone:281-328-8346
Mailing Address - Fax:
Practice Address - Street 1:14700 FM 2100 RD
Practice Address - Street 2:SUITE4
Practice Address - City:CROSBY
Practice Address - State:TX
Practice Address - Zip Code:77532-9161
Practice Address - Country:US
Practice Address - Phone:281-328-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1186843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00636YMedicare PIN
TX8L19944Medicare PIN