Provider Demographics
NPI:1639264138
Name:BUSHEE, STEPHEN PHILIP (ATC, LATC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PHILIP
Last Name:BUSHEE
Suffix:
Gender:M
Credentials:ATC, LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 HEARTHSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-655-3495
Mailing Address - Fax:617-552-9101
Practice Address - Street 1:BOSTON COLLEGE, CONTE FORUM-ROOM 124
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:617-552-3009
Practice Address - Fax:617-552-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10350OtherNATA CERTIFICATION NUMBER
MA250OtherSTATE LICENSE NUMBER
MA215674OtherSTATE SERIAL NUMBER