Healthcare Provider Details

I. General information

NPI: 1265632053
Provider Name (Legal Business Name): ANDREW HARNETT MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 15TH ST 4B
BROOKLYN NY
11215-5631
US

IV. Provider business mailing address

372 15TH ST 4B
BROOKLYN NY
11215-5631
US

V. Phone/Fax

Practice location:
  • Phone: 917-690-0648
  • Fax:
Mailing address:
  • Phone: 917-690-0648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number022351
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: