Healthcare Provider Details

I. General information

NPI: 1023067006
Provider Name (Legal Business Name): JAMES MICHAEL ANDELIN MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12882 PATRICK HENRY HWY
AMELIA VA
23002-3929
US

IV. Provider business mailing address

2570 GLENRIDGE CT
POWHATAN VA
23139-5954
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-1617
  • Fax: 804-561-1618
Mailing address:
  • Phone: 804-598-9356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: