Provider Demographics
NPI:1790137768
Name:BJURSTROM, TERESA (ATC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BJURSTROM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-2709
Mailing Address - Country:US
Mailing Address - Phone:563-320-1530
Mailing Address - Fax:
Practice Address - Street 1:2410 W 58TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-2709
Practice Address - Country:US
Practice Address - Phone:563-320-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer