Basic Information
| Provider Information | |||||||||
| NPI: | 1174595482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLATT | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13609 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285613609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526369800 | ||||||||
| FaxNumber: | 2526361945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1202 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HAVELOCK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285322405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524474005 | ||||||||
| FaxNumber: | 2524474001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2006 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 8751 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7211375 | 05 | NC | MEDICAID | 078JF | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER |