Individual
ANDREW M ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1300 EGG HARBOR RD STE 152, STURGEON BAY, WI 54235-1248
(920) 746-0410
Mailing address
323 S 18TH AVE, STURGEON BAY, WI 54235-1401
(920) 746-0410
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40403200
—
WI
Enumeration date
08/25/2006
Last updated
01/09/2023
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