MEDICARE: MR. MICHAEL DAVID ANDREWS MPT

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
1	225100000X	Physical Therapist	5501011086	MI

General Provider Information

NPI Number	:	1356300750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL DAVID ANDREWS MPT

Provider Business Mailing Address
First Line	:	1320 BISHOP
Second Line	:
City	:	GROSSE POINTE
State	:	MI
Zip	:	48230
Country	:	US
Telephone Number	:	248-765-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	47085 GRATIOT
Second Line	:
City	:	CHESTERFIELD TOWNSHIP
State	:	MI
Zip	:	48051
Country	:	US
Telephone Number	:	586-598-1247
Fax Number	:	586-598-1260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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