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JORDAN M BUSH ATC, LAT

Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1366894719

Individual Registrant:
 JORDAN M BUSH ATC, LAT
Gender: F
Not Sole Proprietor

Location and contact information for practice:
400 SW 258TH ST  NEWBERRY, FL 32669-4112 US
Tel: 315-777-1323  Fax: --

Contact information for business:
26761 LIMESTONE RD  REDWOOD, NY 13679-4184 US
Tel: 315-777-1323  Fax: --

Registration Information:
NPI: 1366894719
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Specialist/Technologist
Athletic Trainer
FLAL 4544

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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