Provider Demographics
NPI:1194016691
Name:BUSH, JOHN ANDREW (PTA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:BUSH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 SHORE RD
Mailing Address - Street 2:#B
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2440
Mailing Address - Country:US
Mailing Address - Phone:609-602-0673
Mailing Address - Fax:
Practice Address - Street 1:1031 SHORE RD
Practice Address - Street 2:#B
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-2440
Practice Address - Country:US
Practice Address - Phone:609-602-0673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00210400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant