Healthcare Provider Details

I. General information

NPI: 1932537834
Provider Name (Legal Business Name): ANDREW MICHAEL LEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2013
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 E CRESCENT DR
MANITOWOC WI
54220-2417
US

IV. Provider business mailing address

1011 E CRESCENT DR
MANITOWOC WI
54220-2417
US

V. Phone/Fax

Practice location:
  • Phone: 920-304-2052
  • Fax:
Mailing address:
  • Phone: 920-304-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number12320-24
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: