Provider Demographics
NPI:1063246155
Name:DAX, ANDREW ALLEN (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ALLEN
Last Name:DAX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 E BOISE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-7618
Mailing Address - Country:US
Mailing Address - Phone:480-436-4313
Mailing Address - Fax:480-807-1782
Practice Address - Street 1:7205 E SOUTHERN AVE STE 111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-2791
Practice Address - Country:US
Practice Address - Phone:480-832-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-033785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist