Provider Demographics
NPI:1952508335
Name:BUSSEY, RICKY L JR (DPT)
Entity Type:Individual
Prefix:MR
First Name:RICKY
Middle Name:L
Last Name:BUSSEY
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4731 S 153RD CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-5025
Mailing Address - Country:US
Mailing Address - Phone:402-316-9060
Mailing Address - Fax:
Practice Address - Street 1:559 W 15TH ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-1280
Practice Address - Country:US
Practice Address - Phone:402-443-4555
Practice Address - Fax:402-443-4554
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE659OtherSTATE LICENSE