Provider Demographics
NPI:1891754776
Name:FITZANKO, DREW ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DREW
Middle Name:ALAN
Last Name:FITZANKO
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 1:209 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:IL
Mailing Address - Zip Code:61010-1458
Mailing Address - Country:US
Mailing Address - Phone:815-234-5553
Mailing Address - Fax:815-234-5557
Practice Address - Street 1:209 N. UNION ST.
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:IL
Practice Address - Zip Code:61010-0600
Practice Address - Country:US
Practice Address - Phone:815-234-5553
Practice Address - Fax:815-234-5557
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010923225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K34624Medicare PIN