Healthcare Provider Details

I. General information

NPI: 1992230569
Provider Name (Legal Business Name): ANDREW DEAN ALFREY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27620 LANDAU BLVD STE 3
CATHEDRAL CITY CA
92234-5540
US

IV. Provider business mailing address

27620 LANDAU BLVD STE 3
CATHEDRAL CITY CA
92234-5540
US

V. Phone/Fax

Practice location:
  • Phone: 760-322-5090
  • Fax: 760-322-9175
Mailing address:
  • Phone: 760-322-5090
  • Fax: 760-322-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA48585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: