Provider Demographics
NPI:1851438493
Name:BUSCH, JOHN A (LICENSED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:BUSCH
Suffix:
Gender:M
Credentials:LICENSED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 KENEDY LEAF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5513
Mailing Address - Country:US
Mailing Address - Phone:210-863-0561
Mailing Address - Fax:
Practice Address - Street 1:540 MADISON OAK DR STE 270
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3930
Practice Address - Country:US
Practice Address - Phone:210-509-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist