Healthcare Provider Details

I. General information

NPI: 1972693364
Provider Name (Legal Business Name): CRAIG ARLAN JAMISON DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BERTEAU AVE
ELMHURST IL
60126-2966
US

IV. Provider business mailing address

796 S SPRING RD
ELMHURST IL
60126-4724
US

V. Phone/Fax

Practice location:
  • Phone: 630-782-7879
  • Fax:
Mailing address:
  • Phone: 630-834-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070017356
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number96001598
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: