Provider Demographics
NPI:1487109294
Name:PLACE, ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PLACE
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 1:2350 BENTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0590
Mailing Address - Country:US
Mailing Address - Phone:910-339-1731
Mailing Address - Fax:910-339-1710
Practice Address - Street 1:1801 OLIVE CHAPEL RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-8586
Practice Address - Country:US
Practice Address - Phone:919-535-8758
Practice Address - Fax:919-535-3271
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025461225100000X
NCP16620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist