Provider Demographics
NPI:1508899535
Name:BUSKO, ABBY L (PT)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:L
Last Name:BUSKO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:82 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:PA
Practice Address - Zip Code:19311-1209
Practice Address - Country:US
Practice Address - Phone:610-268-5333
Practice Address - Fax:610-268-5331
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQA01148600225100000X
PAPT006768L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA236949VKFMedicare PIN
NJ093598R3ZMedicare ID - Type Unspecified