Drew Alan Fitzanko, PT
Individual provider Active NPI Physical Therapist · Byron, IL
NPI 1891754776 · NPPES record last updated Sep 5, 2012
Key facts
- NPI
- 1891754776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070010923 (IL)
- Practice address
- 209 N. Union St.
Byron, IL 61010-0600 - Phone
- (815) 234-5553
- Fax
- (815) 234-5557
- NPI assigned
- Mar 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ortho Rehab Specialists PLLC
Practice addresses (Care Compare)
209 N Union St
Byron, IL 61010-8626
Phone (815) 234-5553
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070208000453 | IL | Practitioner - Physical Therapist in Private Practice | 7012919772 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070010923 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ortho Rehab Specialists PLLC | Physical Therapist | Current |
Accepting new patients |
| Belvidere Rehab & Sports Medicine | Physical Therapist | Past |
Accepting new patients |
Locations
1255 Logan Ave
Belvidere, IL 61008
Phone (815) 547-4733
201 Lincoln Statue Dr
Ste 102
Dixon, IL 61021
Phone (815) 284-1700
201 Lincoln Statue Dr
Dixon, IL 61021
Phone (815) 284-1700
2662 McFarland Rd
Rockford, IL 61107
Phone (815) 226-8780
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070010923 | IL | Yes |
Addresses
Primary practice location
209 N. Union St.
Byron, IL 61010-0600
Mailing address
209 S Union St
Byron, IL 61010-1458
Phone (815) 234-5553
Other providers in Byron, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.