Basic Information
| Provider Information | |||||||||
| NPI: | 1992412852 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAYAK | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | ROGER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11065 GOLDEN PHEASANT DR | ||||||||
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| City: | OSCEOLA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465618511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746077473 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 N WASHINGTON ST | ||||||||
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| City: | WAKARUSA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465739590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5748624511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06001452A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.