Basic Information
| Provider Information | |||||||||
| NPI: | 1942525449 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | CASEY | ||||||||
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| Credential: | MS,MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21316 MACK AVE | ||||||||
| Address2: | |||||||||
| City: | GROSSE POINTE WOODS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482361047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487334325 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4284 TRAIL BOSS DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | CASTLE ROCK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036638086 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2010 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 5501019764 | MI | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 10389 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.