Andrew Baltazar, PTA
Individual provider Active NPI Physical Therapy Assistant · Buffalo Grove, IL
NPI 1144039397 · NPPES record last updated Jan 2, 2025
Key facts
- NPI
- 1144039397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- 160.010311 (IL)
- Practice address
- 404 McHenry Rd
Buffalo Grove, IL 60089-6740 - Phone
- (847) 885-0078
- NPI assigned
- Jan 2, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.010311 | IL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Barrington Orthopedic Specialists LTD | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.010311 | IL | Yes |
Addresses
Primary practice location
404 McHenry Rd
Buffalo Grove, IL 60089-6740
Mailing address
404 McHenry Rd
Buffalo Grove, IL 60089-6740
Phone (847) 885-0078
Other providers in Buffalo Grove, IL
- Back to Function Physical Therapy LLC
- Elizabeth Badowski
- Mariana Baker
- Rhonda Levora Baldwin
- Sharon Elizabeth Balicki
- Nelli Ban
- Oksana Batejko
- Sara Bayerle
- Kristin Bean
- Faith Salesin Becker
All providers in Buffalo Grove, IL · Physical Therapy Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.