Provider Demographics
NPI:1922651702
Name:BUSH, JENNIFER RUTH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RUTH
Last Name:BUSH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 MARE CT SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6841
Mailing Address - Country:US
Mailing Address - Phone:360-701-7014
Mailing Address - Fax:
Practice Address - Street 1:100 RUBY ST SE STE F
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6724
Practice Address - Country:US
Practice Address - Phone:360-943-4797
Practice Address - Fax:360-709-0542
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60942393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist