Individual
ANDREA BUNCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
5414 N BROADWAY ST, CHICAGO, IL 60640-1704
(177) 390-7359
Mailing address
5414 N BROADWAY ST, CHICAGO, IL 60640-1704
(773) 907-3599
(773) 907-3510
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
070021790
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070021790
STATE LICENSE
IL
Enumeration date
09/01/2015
Last updated
09/01/2015
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