Provider Demographics
NPI:1598705048
Name:BUSS, BRENDA (PTA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:BUSS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 EASTON RD
Mailing Address - Street 2:SUITE L700
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2906
Mailing Address - Country:US
Mailing Address - Phone:215-918-5610
Mailing Address - Fax:215-918-5612
Practice Address - Street 1:847 EASTON RD
Practice Address - Street 2:SUITE L700
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2906
Practice Address - Country:US
Practice Address - Phone:215-918-5610
Practice Address - Fax:215-918-5612
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011175L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074028FH3Medicare ID - Type Unspecified