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JORDAN M BUSH ATC, LAT
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1366894719
Individual Registrant: JORDAN M BUSH ATC, LAT
Gender: F
Not Sole Proprietor
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: --
Tel: 315-777-1323 Fax: --
Contact information for business:
26761 LIMESTONE RD REDWOOD, NY 13679-4184 US
Tel: 315-777-1323 Fax: --
Tel: 315-777-1323 Fax: --
Registration Information:
NPI: 1366894719
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | FL | AL 4544 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
