Provider Demographics
NPI:1366176067
Name:HALDEMAN, ANDREW G (MS, ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:HALDEMAN
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 N UNIVERSITY ST APT 409
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2729
Mailing Address - Country:US
Mailing Address - Phone:651-285-6965
Mailing Address - Fax:
Practice Address - Street 1:1600 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1027
Practice Address - Country:US
Practice Address - Phone:309-676-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3006-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer