Healthcare Provider Details

I. General information

NPI: 1295060838
Provider Name (Legal Business Name): ANDREW DAVID KURTZ DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19119 N CREEK PKWY STE 107
BOTHELL WA
98011-8036
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-8800
  • Fax: 425-486-8848
Mailing address:
  • Phone: 630-296-2223
  • Fax: 630-759-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60108403
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009612
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0290918
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerDEPT. OF LABOR AND INDUSTRIES

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: