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NPI Code Detail

MEDICARE: ANDREW LOLLAR

MEDICARE:   ANDREW  LOLLAR
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
12251X0800XOrthopedic Physical Therapist

General Provider Information

NPI Number : 1972027910
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW LOLLAR
Provider Business Mailing Address
First Line : 3622 S ARBOR LAKE DR
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-7762
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7421 S OUTER 364 STE B
Second Line :
City : DARDENNE PRAIRIE
State : MO
Zip : 63368-7014
Country : US
Telephone Number : 636-561-2060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2017
Last Update Date : 08/01/2017

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