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General NPI Number Information
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NPI Number | 1275737694
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Entity Type | Individual
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Provider Name | ANDREW MEDALLA PT
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 12/06/2017
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Provider Practice Location Address
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Address Line | 31868 TOVENIA DR.
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City | BROWNSTOWN
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State | MI
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Zip | 48173-8756
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Country | US
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Telephone | 734-236-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 11650 BELLEVILLE RD STE 102
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City | BELLEVILLE
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State | MI
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Zip | 48111-3382
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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