Healthcare Provider Details

I. General information

NPI: 1982762860
Provider Name (Legal Business Name): ANDREW PHILIP STICKEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 EVANS TO LOCKS RD STE C
EVANS GA
30809-3603
US

IV. Provider business mailing address

PO BOX 1249 4405 EVANS TO LOCK ROAD SUITE C
EVANS GA
30809-1249
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-1598
  • Fax: 706-854-8136
Mailing address:
  • Phone: 706-854-1598
  • Fax: 706-854-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007376
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: