Healthcare Provider Details

I. General information

NPI: 1790451219
Provider Name (Legal Business Name): ANDREW JOSEPH NIELSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/18/2023
Certification Date: 08/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 DORCHESTER AVE STE B
CAMBRIDGE MD
21613-2425
US

IV. Provider business mailing address

475 ALLENDALE RD STE 206
KING OF PRUSSIA PA
19406-1495
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-5100
  • Fax:
Mailing address:
  • Phone: 610-270-0370
  • Fax: 610-270-0374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29531
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT029699
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: