Provider Demographics
NPI:1962467613
Name:PRZYBYSZ, ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:PRZYBYSZ
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 1:336 S LANCELOT LN
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60074-6822
Mailing Address - Country:US
Mailing Address - Phone:847-577-0840
Mailing Address - Fax:
Practice Address - Street 1:6445 N CENTRAL AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2901
Practice Address - Country:US
Practice Address - Phone:773-594-0225
Practice Address - Fax:773-763-5398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK20151Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER