Provider Demographics
NPI:1518506245
Name:EBERT, ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:EBERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 LINDLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2428
Mailing Address - Country:US
Mailing Address - Phone:717-803-3342
Mailing Address - Fax:
Practice Address - Street 1:1952 WADDLE RD STE 103
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-1649
Practice Address - Country:US
Practice Address - Phone:814-413-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-28
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028177225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist