Organization
FMDCE/ MONTCLARE PHYSICAL THERAPY
Active
Other names
Montclare Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW M BARTKOWSKI M.SC., R.P.T. (PRESIDENT)
(847) 328-7316
Entity
Organization
Contact information
Practice address
1927 SHERMAN AVE, SUITE #3, EVANSTON, IL 60201-6100
(847) 328-7316
(847) 328-7316
Mailing address
1927 SHERMAN AVE, SUITE #3, EVANSTON, IL 60201-6100
(847) 328-7316
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070006767
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070006767
PHYSICAL THERAPIST
IL
01
—
21630322
BLUE CROSS BLUE SHIELD
IL
Enumeration date
07/23/2007
Last updated
07/23/2007
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