Healthcare Provider Details

I. General information

NPI: 1720901531
Provider Name (Legal Business Name): ANDREW THOMAS PERSONS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 ASH ST STE 1103-05
SPOONER WI
54801-1201
US

IV. Provider business mailing address

5912 CUMMING AVE
SUPERIOR WI
54880-7214
US

V. Phone/Fax

Practice location:
  • Phone: 715-883-1904
  • Fax:
Mailing address:
  • Phone: 715-817-5250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1998-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: