Provider Demographics
NPI:1609493089
Name:BUSH, JAMES DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:BUSH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HOMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-4522
Mailing Address - Country:US
Mailing Address - Phone:334-268-9584
Mailing Address - Fax:
Practice Address - Street 1:1147 HIGHWAY 231 S STE 9&10
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3026
Practice Address - Country:US
Practice Address - Phone:334-465-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer