Healthcare Provider Details

I. General information

NPI: 1548770050
Provider Name (Legal Business Name): JVB PT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15632 CENTENNIAL CT
ORLAND PARK IL
60462-4571
US

IV. Provider business mailing address

15632 CENTENNIAL CT
ORLAND PARK IL
60462-4571
US

V. Phone/Fax

Practice location:
  • Phone: 773-718-3814
  • Fax:
Mailing address:
  • Phone: 773-718-3814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAIME VAN BUSKIRK
Title or Position: OWNER
Credential: PT, DPT
Phone: 773-718-3814