Provider Demographics
NPI:1043370463
Name:EINHORN, ANDREW RICHARD (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RICHARD
Last Name:EINHORN
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 1:5152 KATELLA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2843
Mailing Address - Country:US
Mailing Address - Phone:562-431-6004
Mailing Address - Fax:562-431-9854
Practice Address - Street 1:5152 KATELLA AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2843
Practice Address - Country:US
Practice Address - Phone:562-431-6004
Practice Address - Fax:562-431-9854
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA126026700OtherDOL
CA126026700OtherDOL
CA126026700OtherDOL
CAR36075Medicare UPIN