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NPI Code Detail

MEDICARE: BROOKE L BULANDA PT, DPT

MEDICARE: BROOKE L BULANDA PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070.029335IL

General Provider Information

NPI Number : 1285511063
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE L BULANDA PT, DPT
Provider Business Mailing Address
First Line : 420 WEXFORD DR
Second Line :
City : LEMONT
State : IL
Zip : 60439-6153
Country : US
Telephone Number : 773-457-2311
Fax Number :
Provider Business Practice Location Address
First Line : 3551 HIGHLAND AVE STE 100
Second Line :
City : DOWNERS GROVE
State : IL
Zip : 60515-2160
Country : US
Telephone Number : 630-275-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2025
Last Update Date : 08/21/2025

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