Active NPI
Jennifer Lynn Van Bussel, BSC. PT
- Physical Therapist
- Jacksonville, FL
National Provider Identifier
1063692309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 23690
- Practice address
- 3901 University Blvd S
Jacksonville, FL 32216-4312 - Phone
- (904) 858-7200
- Fax
- (904) 858-7240
- NPI assigned
- Nov 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 23690 | FL | Primary |
Addresses
Primary practice location
3901 University Blvd S
Jacksonville, FL 32216-4312
Mailing address
10435 Midtown Pkwy Unit 129
Jacksonville, FL 32246-7463
Phone (904) 641-7966
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 23690 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194134400000",
"number": "1063692309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10435 MIDTOWN PKWY UNIT 129",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322467463",
"telephone_number": "904-641-7966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3901 UNIVERSITY BLVD S",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322164312",
"telephone_number": "904-858-7200",
"fax_number": "904-858-7240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BUSSEL",
"first_name": "JENNIFER",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "BSC. PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-11-04",
"last_updated": "2007-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 23690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.