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NPI Code Detail

MEDICARE: ANDREA DISTLER LAMM DPT

MEDICARE: ANDREA DISTLER LAMM DPT
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 Therapist008055KY
2225100000XPhysical Therapist05015556AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1008055OTHERKYKY PT LICENSE

General Provider Information

NPI Number : 1336764133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA DISTLER LAMM DPT
Provider Business Mailing Address
First Line : 3626 GRANT LINE RD STE 105
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2399
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3626 GRANT LINE RD STE 105
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-2399
Country : US
Telephone Number : 812-944-1377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2020
Last Update Date : 03/18/2025

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Directions to “ ANDREA DISTLER LAMM DPT” Practice Location

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