Individual
JENNIFER R BURBAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Contact information
Practice address
1738 165TH ST, SUITE A, HAMMOND, IN 46320-2821
(219) 844-1782
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006912A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000300593
ANTHEM - APT PLUS
IN
01
—
000000324517
ANTHEM - MBWOUDE
IN
01
—
000000325382
ANTHEM - 1ST AID PLUS
IN
Enumeration date
06/06/2006
Last updated
10/05/2015
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