Provider Demographics
NPI:1932934890
Name:STOTLER, ANDREW (LMT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:STOTLER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 RITCHIE HWY STE I
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6940
Mailing Address - Country:US
Mailing Address - Phone:410-647-2225
Mailing Address - Fax:
Practice Address - Street 1:8131 RITCHIE HWY STE I
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6940
Practice Address - Country:US
Practice Address - Phone:410-647-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist