Provider Demographics
NPI:1750764312
Name:FANDRICH, ALVIN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:
Last Name:FANDRICH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 BIENVILLET ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119
Mailing Address - Country:US
Mailing Address - Phone:504-533-8267
Mailing Address - Fax:
Practice Address - Street 1:3525 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-5249
Practice Address - Country:US
Practice Address - Phone:877-311-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist