Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070006767 | IL |
N | 2251S0007X | Physical Therapist - Sports | 070006767 | IL |
NPI | 1235257213 |
---|---|
Provider Name | Dr. Andrew M Bartkowski |
First Address | Evanston, IL 60201-6100 |
Second Address | Evanston, IL 60201-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
21630322 | (02) | IL |