Healthcare Provider Details

I. General information

NPI: 1144826868
Provider Name (Legal Business Name): ANDREW MCCLESKEY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 S TEXAS AVE
BRYAN TX
77802-1834
US

IV. Provider business mailing address

101 HARPERS FERRY ST
VICTORIA TX
77904-2411
US

V. Phone/Fax

Practice location:
  • Phone: 979-599-5900
  • Fax:
Mailing address:
  • Phone: 361-676-2445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2151464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: