Provider Demographics
NPI:1124245949
Name:LOHMAR, ANDREAS (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:
Last Name:LOHMAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 MERCHANDISE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT. WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-484-9491
Mailing Address - Fax:260-484-9451
Practice Address - Street 1:5310 MERCHANDISE DRIVE
Practice Address - Street 2:
Practice Address - City:FT. WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-484-9491
Practice Address - Fax:260-484-9451
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5002908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5002908OtherSTATE LICENSE