Healthcare Provider Details

I. General information

NPI: 1639504863
Provider Name (Legal Business Name): JONATHAN M ANDALIKIEWICZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2013
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N STATE ROUTE 7 STE B
PLEASANT HILL MO
64080-8005
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
BIRMINGHAM AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 816-987-7049
  • Fax: 816-987-2606
Mailing address:
  • Phone: 816-226-4011
  • Fax: 816-524-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-04681
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2013040526
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: