Healthcare Provider Details

I. General information

NPI: 1295119816
Provider Name (Legal Business Name): ANDREW PLAYTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 9TH STREET EAST
OWEN SOUND ONTARIO
N4K 1P4
CA

IV. Provider business mailing address

535 9TH STREET EAST
OWEN SOUND ONTARIO
N4K 1P4
CA

V. Phone/Fax

Practice location:
  • Phone: 519-377-2822
  • Fax:
Mailing address:
  • Phone: 519-377-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001424
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: