Provider Demographics
NPI:1932459609
Name:BUSSEY, MARCUS (LMP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 S 10TH ST
Mailing Address - Street 2:APT #705
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-2067
Mailing Address - Country:US
Mailing Address - Phone:253-232-6820
Mailing Address - Fax:
Practice Address - Street 1:6410 S 10TH ST
Practice Address - Street 2:APT #705
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98465-2067
Practice Address - Country:US
Practice Address - Phone:253-232-6820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60311842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist