Provider Demographics
NPI:1336548262
Name:JUSKA, BIRUTE
Entity Type:Individual
Prefix:
First Name:BIRUTE
Middle Name:
Last Name:JUSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26605 SAINT ANNS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9256
Mailing Address - Country:US
Mailing Address - Phone:708-421-1976
Mailing Address - Fax:
Practice Address - Street 1:2600 MOREHOUSE AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-2552
Practice Address - Country:US
Practice Address - Phone:574-295-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011326A225100000X
MI5501013394225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist