Provider Demographics
NPI:1770922270
Name:MEDVED, ANDREW JAMES (ATC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:JAMES
Last Name:MEDVED
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39141 FARRINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LEETONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44431-8709
Mailing Address - Country:US
Mailing Address - Phone:330-718-2869
Mailing Address - Fax:
Practice Address - Street 1:302 BUCHTEL MALL
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44325-0001
Practice Address - Country:US
Practice Address - Phone:330-718-2869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0039862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer