Provider Demographics
NPI:1255471256
Name:BEDNARCHIK, ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:
Last Name:BEDNARCHIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20073 PORTER PL UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3090
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1876
Practice Address - Street 2:NE HIGHWAY 20
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4898
Practice Address - Country:US
Practice Address - Phone:541-382-5531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist