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Organization

ANDERSONVILLE PHYSICAL THERAPY, SC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PATRICIA STASZAK PT (MANAGER)
(773) 907-3599
Entity
Organization

Contact information

Practice address
5414 N BROADWAY ST, CHICAGO, IL 60640-1704
(773) 907-3599
(773) 907-3510
Mailing address
5414 N BROADWAY ST, CHICAGO, IL 60640-1704
(773) 907-3599
(773) 907-3510

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070008600
IL
225100000X
Physical Therapist
Primary
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1623236
BCBS
IL
01
600037500
US DEPT OF LABOR
IL
01
650021537
RAILROAD MEDICARE
IL
Enumeration date
01/08/2007
Last updated
05/08/2026
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