Provider Demographics
NPI:1508528233
Name:BUSE, JONATHAN PAYNE (MM, MT-BC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:PAYNE
Last Name:BUSE
Suffix:
Gender:M
Credentials:MM, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 MAGUIRE BLVD APT 3115
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7216
Mailing Address - Country:US
Mailing Address - Phone:615-522-2512
Mailing Address - Fax:
Practice Address - Street 1:12751 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4113
Practice Address - Country:US
Practice Address - Phone:321-370-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12696OtherCERTIFICATION BOARD FOR MUSIC THERAPISTS