MEDICARE: MR. ROBERT ANDREW PRZYBYSZ P.T.

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
1	225100000X	Physical Therapist	5501002594	MI

General Provider Information

NPI Number	:	1093712192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ANDREW PRZYBYSZ P.T.

Provider Business Mailing Address
First Line	:	335 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-3363
Fax Number	:	616-392-9030

Provider Business Practice Location Address
First Line	:	335 120TH AVE
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49424-2118
Country	:	US
Telephone Number	:	616-392-3363
Fax Number	:	616-392-9030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	06/27/2016

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Directions to “ MR. ROBERT ANDREW PRZYBYSZ P.T.” Practice Location

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