Individual
ANDREW HAVERSTOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
344 S WALNUT RIDGE CT, FRANKFORT, IL 60423-2129
(219) 229-0322
(708) 479-2111
Mailing address
344 S WALNUT RIDGE CT, FRANKFORT, IL 60423-2129
(219) 229-0322
(708) 479-2111
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05007676A
IN
225100000X
Physical Therapist
070012822
IL
2251P0200X
Pediatric Physical Therapist
Primary
070012822
IL
Other
Enumeration date
04/23/2007
Last updated
10/15/2015
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