Healthcare Provider Details

I. General information

NPI: 1538636709
Provider Name (Legal Business Name): ANDREW KAWAMLEH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MARINER HEALTH WAY
ST AUGUSTINE FL
32086-3215
US

IV. Provider business mailing address

10000 GATE PKWY N APT 1625
JACKSONVILLE FL
32246-8216
US

V. Phone/Fax

Practice location:
  • Phone: 904-794-9988
  • Fax:
Mailing address:
  • Phone: 904-708-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA28978
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: