Healthcare Provider Details

I. General information

NPI: 1134555147
Provider Name (Legal Business Name): ANDREW STEPHEN BIR PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 06/01/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PEARL ST
BURLINGTON VT
05401-8531
US

IV. Provider business mailing address

930 ELIJAH WAY
BETHLEHEM GA
30620-3429
US

V. Phone/Fax

Practice location:
  • Phone: 802-658-4200
  • Fax:
Mailing address:
  • Phone: 706-575-5733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number041.0134004PROV
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP010737A
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberCP018387A
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA003128
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4867
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: