Provider Demographics
NPI:1932239241
Name:MCANDREW, PAUL JOSEPH (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:MCANDREW
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 1:6 E POND RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2584
Mailing Address - Country:US
Mailing Address - Phone:199-489-8809
Mailing Address - Fax:919-489-5099
Practice Address - Street 1:3500 WESTGATE DR STE 504
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2568
Practice Address - Country:US
Practice Address - Phone:919-489-8809
Practice Address - Fax:919-489-5099
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7210443Medicaid
NC2502620Medicare ID - Type Unspecified