Provider Demographics
NPI:1942525449
Name:BUSH, CASEY (MS,MPT)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21316 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1047
Mailing Address - Country:US
Mailing Address - Phone:248-733-4325
Mailing Address - Fax:
Practice Address - Street 1:4284 TRAIL BOSS DR STE 130
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104
Practice Address - Country:US
Practice Address - Phone:303-663-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501019764225100000X
CO10389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist