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General NPI Number Information
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NPI Number | 1972693364
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Entity Type | Individual
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Provider Name | CRAIG ARLAN JAMISON DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 200 N BERTEAU AVE
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City | ELMHURST
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State | IL
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Zip | 60126-2966
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Country | US
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Telephone | 630-782-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 796 S SPRING RD
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City | ELMHURST
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State | IL
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Zip | 60126-4724
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Country | US
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Telephone | 630-834-4920
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 96001598
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070017356
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License Number State | IL
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