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General NPI Number Information
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NPI Number | 1659536118
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Entity Type | Individual
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Provider Name | JAIME LYNN VANBUSKIRK PT, DPT, COMT, CMTPT
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Gender | Female
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 3938 W 111TH ST STE 1B
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-629-6875
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Fax | 844-965-9380
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Provider Business Mailing Address
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Address Line | 15632 CENTENNIAL CT
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City | ORLAND PARK
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State | IL
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Zip | 60462-4571
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Country | US
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Telephone | 773-718-3814
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Fax | 844-908-9499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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