Provider Demographics
NPI:1316487911
Name:COLLENTRO, ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:COLLENTRO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6400
Mailing Address - Country:US
Mailing Address - Phone:512-206-0433
Mailing Address - Fax:512-206-0797
Practice Address - Street 1:1600 W 38TH ST
Practice Address - Street 2:STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6400
Practice Address - Country:US
Practice Address - Phone:512-206-0433
Practice Address - Fax:512-206-0797
Is Sole Proprietor?:No
Enumeration Date:2017-03-01
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1276095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist