Provider Demographics
NPI:1851046114
Name:BOSAK, ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:BOSAK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17430 N PORTER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-4790
Mailing Address - Country:US
Mailing Address - Phone:480-766-3025
Mailing Address - Fax:
Practice Address - Street 1:17430 N PORTER RD STE 110
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4790
Practice Address - Country:US
Practice Address - Phone:520-208-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist