Provider Demographics
NPI:1720134448
Name:BUSENBARK, CHERIE MARIE (MS PT)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:MARIE
Last Name:BUSENBARK
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 VICTORY HL
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46121-8962
Mailing Address - Country:US
Mailing Address - Phone:765-386-2535
Mailing Address - Fax:765-386-2535
Practice Address - Street 1:123 VICTORY HL
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46121-8962
Practice Address - Country:US
Practice Address - Phone:765-386-2535
Practice Address - Fax:765-386-2535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05006547A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist