Healthcare Provider Details

I. General information

NPI: 1235257213
Provider Name (Legal Business Name): ANDREW M BARTKOWSKI R.P.T.,M.SC.,M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 SHERMAN AVE # 3
EVANSTON IL
60201-6100
US

IV. Provider business mailing address

1927 SHERMAN AVE # 3
EVANSTON IL
60201-6100
US

V. Phone/Fax

Practice location:
  • Phone: 847-328-7316
  • Fax: 847-425-5155
Mailing address:
  • Phone: 847-328-7316
  • Fax: 847-425-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070006767
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number070006767
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: