Individual
KEANU ANDICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Mailing address
6177 RIVER CREST DR STE A, RIVERSIDE, CA 92507-0728
(951) 653-4480
(951) 653-5051
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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