Provider Demographics
NPI:1881980324
Name:BURCHETT, ANDREW RYAN (PT, ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:BURCHETT
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213
Mailing Address - Country:US
Mailing Address - Phone:513-618-7878
Mailing Address - Fax:513-618-7888
Practice Address - Street 1:5400 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45213
Practice Address - Country:US
Practice Address - Phone:513-618-7878
Practice Address - Fax:513-618-7888
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist