Provider Demographics
NPI:1063692309
Name:VAN BUSSEL, JENNIFER LYNN (BSC PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:VAN BUSSEL
Suffix:
Gender:F
Credentials:BSC PT
Other - Prefix:
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Mailing Address - Street 1:10435 MIDTOWN PKWY UNIT 129
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7463
Mailing Address - Country:US
Mailing Address - Phone:904-641-7966
Mailing Address - Fax:
Practice Address - Street 1:3901 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4312
Practice Address - Country:US
Practice Address - Phone:904-858-7200
Practice Address - Fax:904-858-7240
Is Sole Proprietor?:No
Enumeration Date:2007-11-04
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT 23690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist