Provider Demographics
NPI:1659922656
Name:SHIRK, ANDREW LEWIS JEND (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEWIS JEND
Last Name:SHIRK
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 1:7979 W RIFLEMAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9066
Mailing Address - Country:US
Mailing Address - Phone:208-377-3850
Mailing Address - Fax:208-369-9272
Practice Address - Street 1:3015 E MAGIC VIEW DR STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-3750
Practice Address - Country:US
Practice Address - Phone:208-887-3498
Practice Address - Fax:208-369-9272
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT7119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist