Provider Demographics
NPI:1609187483
Name:BUSHFIELD, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUSHFIELD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 DAKOTA AVE S
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-4022
Mailing Address - Country:US
Mailing Address - Phone:605-352-9498
Mailing Address - Fax:605-352-3452
Practice Address - Street 1:1552 DAKOTA AVE S
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350-4022
Practice Address - Country:US
Practice Address - Phone:605-352-9498
Practice Address - Fax:605-352-3452
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist