Provider Demographics
NPI:1982996781
Name:BUSH, NYLA JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:NYLA
Middle Name:JEAN
Last Name:BUSH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 W MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2573
Mailing Address - Country:US
Mailing Address - Phone:406-535-9914
Mailing Address - Fax:
Practice Address - Street 1:618 W MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2573
Practice Address - Country:US
Practice Address - Phone:406-535-9914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist