Provider Demographics
NPI:1659308518
Name:BUSH, MENDY A (PT)
Entity Type:Individual
Prefix:
First Name:MENDY
Middle Name:A
Last Name:BUSH
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 1:5812 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6356
Mailing Address - Country:US
Mailing Address - Phone:972-529-9180
Mailing Address - Fax:
Practice Address - Street 1:8080 STATE HIGHWAY 121
Practice Address - Street 2:SUITE 310
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-359-8502
Practice Address - Fax:972-359-1749
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist