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NPI Code Detail

MEDICARE: ANDREA NEWPORT PT

MEDICARE: ANDREA NEWPORT PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist6548MN

General Provider Information

NPI Number : 1508953126
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA NEWPORT PT
Provider Business Mailing Address
First Line : 12217 CHAMPLIN DR
Second Line :
City : CHAMPLIN
State : MN
Zip : 55316-1930
Country : US
Telephone Number : 763-323-1492
Fax Number : 763-422-1657
Provider Business Practice Location Address
First Line : 12217 CHAMPLIN DR
Second Line :
City : CHAMPLIN
State : MN
Zip : 55316-1930
Country : US
Telephone Number : 763-323-1492
Fax Number : 763-422-1657
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 03/19/2019

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Directions to “ ANDREA NEWPORT PT” Practice Location

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