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General NPI Number Information
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NPI Number | 1871363572
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Entity Type | Individual
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Provider Name | ANDREW CHRISTOPHER BOARDMAN PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 14700 KING RD STE B
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City | RIVERVIEW
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State | MI
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Zip | 48193-7909
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Country | US
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Telephone | 734-288-0235
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Fax |
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Provider Business Mailing Address
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Address Line | 1844 11TH ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-3600
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Country | US
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Telephone | 734-258-4366
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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 | 5501303080
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License Number State | MI
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