Provider Demographics
NPI:1407061567
Name:BUSH, MEGAN RAE (MPT)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:RAE
Last Name:BUSH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:KS
Mailing Address - Zip Code:66833-0086
Mailing Address - Country:US
Mailing Address - Phone:620-794-3980
Mailing Address - Fax:
Practice Address - Street 1:NORTH 4TH STREET
Practice Address - Street 2:COFFEY COUNTY HOSPTIAL REHAB SERVICES
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839
Practice Address - Country:US
Practice Address - Phone:620-364-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028085225100000X
KS11-03598225100000X
MO2004030575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist