Provider Demographics
NPI:1821327073
Name:ANDREWS, MICHAEL EUGENE (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EUGENE
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 KISHHOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3125
Mailing Address - Country:US
Mailing Address - Phone:815-748-7800
Mailing Address - Fax:815-758-0717
Practice Address - Street 1:599 PEARSON DR
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1355
Practice Address - Country:US
Practice Address - Phone:815-784-2100
Practice Address - Fax:815-784-2110
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist