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General NPI Number Information
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NPI Number | 1275741175
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Entity Type | Individual
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Provider Name | ANDREW TIMOTHY HOLZWARTH PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 2200 NW 26TH ST
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City | OWATONNA
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State | MN
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Zip | 55060-5503
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Country | US
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Telephone | 507-444-5059
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Fax |
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Provider Business Mailing Address
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Address Line | 311 E ROOSEVELT CIR APT 107
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City | MANKATO
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State | MN
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Zip | 56001-6954
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Country | US
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Telephone | 605-638-0649
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0170
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12658
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License Number State | MN
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