MEDICARE: ANDREW PRZYBYSZ PT

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		IL

General Provider Information

NPI Number	:	1962467613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PRZYBYSZ PT

Provider Business Mailing Address
First Line	:	336 S LANCELOT LN
Second Line	:
City	:	PALATINE
State	:	IL
Zip	:	60074-6822
Country	:	US
Telephone Number	:	847-577-0840
Fax Number	:

Provider Business Practice Location Address
First Line	:	6445 N CENTRAL AVE
Second Line	:	FIRST FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60646-2901
Country	:	US
Telephone Number	:	773-594-0225
Fax Number	:	773-763-5398

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	07/08/2007

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