Provider Demographics
NPI:1871926691
Name:MCCANN, ANDREW MICHAEL (PT)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:MCCANN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1542 GOLF COURSE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3555
Mailing Address - Country:US
Mailing Address - Phone:218-326-3300
Mailing Address - Fax:218-326-3400
Practice Address - Street 1:1542 GOLF COURSE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3555
Practice Address - Country:US
Practice Address - Phone:218-326-3300
Practice Address - Fax:218-326-3400
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist