Healthcare Provider Details

I. General information

NPI: 1477883890
Provider Name (Legal Business Name): ANDREW STEVEN HUTCHENS ATC, CSCS, CPT, CKTP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 ROUTE 65
ELLWOOD CITY PA
16117-5217
US

IV. Provider business mailing address

1677 ROUTE 65
ELLWOOD CITY PA
16117-5217
US

V. Phone/Fax

Practice location:
  • Phone: 724-752-2716
  • Fax: 724-752-0990
Mailing address:
  • Phone: 724-752-2716
  • Fax: 724-752-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004055
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: