Provider Demographics
NPI:1972693364
Name:JAMISON, CRAIG ARLAN (DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ARLAN
Last Name:JAMISON
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:796 S SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-4724
Mailing Address - Country:US
Mailing Address - Phone:630-834-4920
Mailing Address - Fax:
Practice Address - Street 1:200 N BERTEAU AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2966
Practice Address - Country:US
Practice Address - Phone:630-782-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960015982255A2300X
IL070017356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer