Provider Demographics
NPI:1750362729
Name:ABRAHAM, ANDREW PAUL (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PAUL
Last Name:ABRAHAM
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 1:2921 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4801
Mailing Address - Country:US
Mailing Address - Phone:501-268-2513
Mailing Address - Fax:501-279-1328
Practice Address - Street 1:2921 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4801
Practice Address - Country:US
Practice Address - Phone:501-268-2513
Practice Address - Fax:501-279-1328
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X493OtherBLUE CROSS BLUE SHIELD
AR150971721Medicaid
AR5X493OtherBLUE CROSS BLUE SHIELD