Individual
MR. BRYAN D JASKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Mailing address
1111 TRINITY LN, SUITE 111, BLOOMINGTON, IL 61704-8111
(309) 663-6461
(309) 661-8107
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
070-014356
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070-014356
IL LICENSE NO
IL
Enumeration date
05/05/2006
Last updated
09/05/2019
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