Healthcare Provider Details

I. General information

NPI: 1275801524
Provider Name (Legal Business Name): SCOTT E ANDREWS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 INTERNATIONAL PKWY SUITE 300
LAKE MARY FL
32746-5061
US

IV. Provider business mailing address

6148 STATE ROUTE 13
BELLVILLE OH
44813-8940
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 419-512-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA 7632
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number9681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: