Provider Demographics
NPI:1538649603
Name:IYERE, BUSARI BUSBRIDGE (PT)
Entity Type:Individual
Prefix:
First Name:BUSARI
Middle Name:BUSBRIDGE
Last Name:IYERE
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 1:7845 WINDCHASE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-8201
Mailing Address - Country:US
Mailing Address - Phone:409-749-0977
Mailing Address - Fax:
Practice Address - Street 1:7845 WINDCHASE DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-8201
Practice Address - Country:US
Practice Address - Phone:409-749-0977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist