Healthcare Provider Details

I. General information

NPI: 1235929878
Provider Name (Legal Business Name): BAILEY JORDAN BURCH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 N ELSTON AVE
CHICAGO IL
60630-2506
US

IV. Provider business mailing address

4123 N CAMPBELL AVE UNIT 2
CHICAGO IL
60618-2805
US

V. Phone/Fax

Practice location:
  • Phone: 773-205-8505
  • Fax:
Mailing address:
  • Phone: 831-600-5134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017788
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307991
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.040006
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: