Provider Demographics
NPI:1356705032
Name:BUSHNELL, MEREDITH S (DPT)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:S
Last Name:BUSHNELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:S
Other - Last Name:HENEGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:625 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8813
Mailing Address - Country:US
Mailing Address - Phone:630-575-6200
Mailing Address - Fax:630-928-5040
Practice Address - Street 1:14700 S LA GRANGE RD
Practice Address - Street 2:UNIT A
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3248
Practice Address - Country:US
Practice Address - Phone:708-873-8822
Practice Address - Fax:708-873-8823
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist