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NPI Code Detail

MEDICARE: ANDERSONVILLE PHYSICAL THERAPY

MEDICARE: ANDERSONVILLE PHYSICAL THERAPY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistIL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11623236OTHERILBCBS

General Provider Information

NPI Number : 1043368731
Entity Type Code : Organization
Provider Name (Legal Business Name) : ANDERSONVILLE PHYSICAL THERAPY
Provider Business Mailing Address
First Line : 5414 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1704
Country : US
Telephone Number : 773-907-3599
Fax Number : 773-907-3510
Provider Business Practice Location Address
First Line : 5414 N BROADWAY ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-1704
Country : US
Telephone Number : 773-907-3599
Fax Number : 773-907-3510
Authorized Official
Title or Position : PRESIDENT
Name : PATRICIA STASZAK
Credential :
Telephone Number : 773-907-3599
Provider Enumeration Date : 01/08/2007
Last Update Date : 01/12/2026

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Directions to “ANDERSONVILLE PHYSICAL THERAPY ” Practice Location

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