Provider Demographics
NPI:1962691238
Name:FLETCHER, DAVID ANDREW (MPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626C ADMIRAL DR # 619
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2180
Mailing Address - Country:US
Mailing Address - Phone:410-401-5354
Mailing Address - Fax:877-805-9545
Practice Address - Street 1:2024 WEST ST STE 101
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3552
Practice Address - Country:US
Practice Address - Phone:410-401-5354
Practice Address - Fax:877-805-9545
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD202N206GMedicare PIN