Healthcare Provider Details

I. General information

NPI: 1003721283
Provider Name (Legal Business Name): EMILY PUSTELNIK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S 4TH ST
BASIN WY
82410-5011
US

IV. Provider business mailing address

16333 OLCOTT AVE
TINLEY PARK IL
60477-1518
US

V. Phone/Fax

Practice location:
  • Phone: 307-568-9399
  • Fax:
Mailing address:
  • Phone: 708-224-1316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: