Provider Demographics
NPI:1841220068
Name:COOPER & BUSH PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:COOPER & BUSH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-731-9331
Mailing Address - Street 1:6080 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3912
Mailing Address - Country:US
Mailing Address - Phone:817-731-9331
Mailing Address - Fax:817-731-9882
Practice Address - Street 1:6080 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3912
Practice Address - Country:US
Practice Address - Phone:817-731-9331
Practice Address - Fax:817-731-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX609990000225100000X
TX521500000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080584801Medicaid
TXCC7622OtherRAILROAD MEDICARE
TX1256670001OtherCMS REGION C DME
TX1256670001OtherCMS REGION C DME
TX080584801Medicaid