Healthcare Provider Details

I. General information

NPI: 1730737719
Provider Name (Legal Business Name): VANESSA SCHUSTER PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA SOUSA

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W ROOSEVELT RD
CHICAGO IL
60608-1316
US

IV. Provider business mailing address

2149 W ROSCOE ST UNIT 2
CHICAGO IL
60618-9243
US

V. Phone/Fax

Practice location:
  • Phone: 312-413-8043
  • Fax:
Mailing address:
  • Phone: 540-398-0952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070025066
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: