1144319179

Everything you always wanted to know about BUESCH JILL DPT but were afraid to ask.

BUESCH JILL DPT

You can also download the this 1144319179 data report as csv | excel | json | xml
Provider Last Name Provider First Name Provider Credential
BUESCH JILL DPT
Gender:
Female
Enumeration date:
2006-10-11
Last update date:
2010-01-07
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
0665430 Medicaid none IA
I19172014 Medicare PIN none IA
I19172 Medicare PIN none IA

Taxonomies

Taxonomy State License Number Primary?
225100000X Physical Therapist IA 3775 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 5159638723
Practice Location Address Telephone Number 5159638723
Mailing Address Fax Number 5159638755
Practice Location Address Fax Number 5159638755

Addresses

Type Address City State Postal Country
Mailing Address 1555 SE DELAWARE AVE SUITE M ANKENY IA 50021 IA
Practice Location Address 1555 SE DELAWARE AVE SUITE M ANKENY IA 50021 IA

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