Provider Demographics
NPI:1346797164
Name:PULLEY, ANDREW (PT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PULLEY
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 1:907 S PALESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3612
Mailing Address - Country:US
Mailing Address - Phone:903-675-0077
Mailing Address - Fax:903-675-0078
Practice Address - Street 1:907 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3612
Practice Address - Country:US
Practice Address - Phone:903-675-0077
Practice Address - Fax:903-675-0078
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3120279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist