Provider Demographics
NPI:1720065501
Name:VANDREASON, STEVEN P (PT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:VANDREASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939
Mailing Address - Street 2:BRITTONFIELD PARKWAY SUITE 103
Mailing Address - City:E.. SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-234-7322
Mailing Address - Fax:315-634-3264
Practice Address - Street 1:4939
Practice Address - Street 2:BRITTONFIELD PARKWAY SUITE 103
Practice Address - City:E.. SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-234-7322
Practice Address - Fax:315-634-3264
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0177291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist