Provider Demographics
NPI:1982762860
Name:STICKEL, ANDREW PHILIP (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHILIP
Last Name:STICKEL
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:PO BOX 1249
Mailing Address - Street 2:4405 EVANS TO LOCK ROAD SUITE C
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-1249
Mailing Address - Country:US
Mailing Address - Phone:706-854-1598
Mailing Address - Fax:706-854-8136
Practice Address - Street 1:4405 EVANS TO LOCKS RD STE C
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-854-1598
Practice Address - Fax:706-854-8136
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist