Provider Demographics
NPI:1952033912
Name:BUSH, MEGAN (MS, ACSM-RCEP,CNC)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:MS, ACSM-RCEP,CNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12324 CRICKLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34610-6534
Mailing Address - Country:US
Mailing Address - Phone:352-206-4697
Mailing Address - Fax:
Practice Address - Street 1:12324 CRICKLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-6534
Practice Address - Country:US
Practice Address - Phone:352-206-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1070953224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist