Provider Demographics
NPI:1003896663
Name:BUSA, CHRISTINE (PT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BUSA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOONE AVE N
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4466
Mailing Address - Country:US
Mailing Address - Phone:763-450-2000
Mailing Address - Fax:763-450-3033
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-843-8436
Practice Address - Fax:602-843-8947
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ987167Medicaid