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General NPI Number Information
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NPI Number | 1720901531
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Entity Type | Individual
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Provider Name | ANDREW THOMAS PERSONS PTA
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Gender | Male
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Dates
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Enumeration Date | 07/30/2026
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Last Update Date | 07/30/2026
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Provider Practice Location Address
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Address Line | 819 ASH ST STE 1103-05
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City | SPOONER
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State | WI
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Zip | 54801-1201
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Country | US
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Telephone | 715-883-1904
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Fax |
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Provider Business Mailing Address
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Address Line | 5912 CUMMING AVE
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City | SUPERIOR
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State | WI
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Zip | 54880-7214
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Country | US
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Telephone | 715-817-5250
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1998-19
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License Number State | WI
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