Provider Demographics
NPI:1639504863
Name:ANDALIKIEWICZ, JONATHAN M (PT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:ANDALIKIEWICZ
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:816-226-4011
Mailing Address - Fax:816-524-6115
Practice Address - Street 1:2001 N STATE ROUTE 7 STE B
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:MO
Practice Address - Zip Code:64080-8005
Practice Address - Country:US
Practice Address - Phone:816-987-7049
Practice Address - Fax:816-987-2606
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04681225100000X
MO2013040526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist