Provider Demographics
NPI:1366586570
Name:ANDREWS, CARL SCOTT (ATC)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:SCOTT
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 WHITE BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1774
Mailing Address - Country:US
Mailing Address - Phone:570-474-6277
Mailing Address - Fax:
Practice Address - Street 1:WILKES UNIVERSITY
Practice Address - Street 2:84 W. SOUTH STREET
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18766-0001
Practice Address - Country:US
Practice Address - Phone:570-408-4027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0036242255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer