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NPI Code Detail

MEDICARE: MR. ANDREW AKIRA SMALL MPHTYST, BSCAPP(HMS)

MEDICARE: MR. ANDREW AKIRA SMALL MPHTYST, BSCAPP(HMS)
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist62034868NY
2225100000XPhysical Therapist13998-24WI

General Provider Information

NPI Number : 1134470677
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANDREW AKIRA SMALL MPHTYST, BSCAPP(HMS)
Provider Business Mailing Address
First Line : 441 E ERIE ST UNIT 231
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-6103
Country : US
Telephone Number : 917-216-1704
Fax Number :
Provider Business Practice Location Address
First Line : 1201 N 6TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-3360
Country : US
Telephone Number : 917-216-1704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2012
Last Update Date : 02/09/2018

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