1053308213 NPI number — DAVID LEE ANDREWS DAVID ANDREWS, ATC

Table of content: DAVID LEE ANDREWS DAVID ANDREWS, ATC (NPI 1053308213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053308213 NPI number — DAVID LEE ANDREWS DAVID ANDREWS, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDREWS
Provider First Name:
DAVID
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DAVID ANDREWS, ATC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053308213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7123 108TH ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98332-8511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-857-9062
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4411 POINT FOSDICK DR NW
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98335-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-851-7472
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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