Healthcare Provider Details

I. General information

NPI: 1477668531
Provider Name (Legal Business Name): BRIAN E BUESCHER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 N. ILLINOIS STREET SUITE C
SWANSEA IL
62226
US

IV. Provider business mailing address

7 EMERALD TER
SWANSEA IL
62226-2321
US

V. Phone/Fax

Practice location:
  • Phone: 618-235-0700
  • Fax:
Mailing address:
  • Phone: 618-235-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070010081
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: