Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 160005013 | IL |
NPI | 1003058215 |
---|---|
Provider Name | Jennifer Abigail Bunag |
First Address | Westmont, IL 60559-3317 |
Second Address | Westmont, IL 60559-3317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2009 |
Last Update Date | 02/04/2009 |