Provider Demographics
NPI:1154450898
Name:BUSHMAN, MARIANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:BUSHMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 JEFFORDS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1011 JEFFORDS ST
Practice Address - Street 2:SUITE B
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4070
Practice Address - Country:US
Practice Address - Phone:727-442-8199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT20825OtherPHYSICAL THERAPIST