Provider Demographics
NPI:1134508906
Name:VAN BUSKIRK, THOMAS EUGENE (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EUGENE
Last Name:VAN BUSKIRK
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W SOVERS ST
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-9636
Mailing Address - Country:US
Mailing Address - Phone:507-440-6842
Mailing Address - Fax:
Practice Address - Street 1:401 ASH ST SW
Practice Address - Street 2:
Practice Address - City:ROSE CREEK
Practice Address - State:MN
Practice Address - Zip Code:55970-8806
Practice Address - Country:US
Practice Address - Phone:507-440-6842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA0878002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program