Provider Demographics
NPI:1831531920
Name:BUSH, CINDY (PTA)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 ELM LEAF
Mailing Address - Street 2:APT 1510
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2957
Mailing Address - Country:US
Mailing Address - Phone:813-763-0530
Mailing Address - Fax:
Practice Address - Street 1:3802 ELM LEAF
Practice Address - Street 2:APT 1510
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2957
Practice Address - Country:US
Practice Address - Phone:813-763-0530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2080520225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant