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General NPI Number Information
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NPI Number | 1619037736
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Entity Type | Individual
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Provider Name | ANDREW C EVERETT PT, ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8500 WILSHIRE BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3121
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Country | US
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Telephone | 310-652-7721
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Fax | 310-652-2616
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Provider Business Mailing Address
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Address Line | 28082 BRIDLEWOOD DR
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City | CASTAIC
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State | CA
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Zip | 91384-4532
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Country | US
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Telephone | 661-702-7995
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Fax | 661-702-7997
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 19875
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License Number State | CA
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