Healthcare Provider Details

I. General information

NPI: 1902667439
Provider Name (Legal Business Name): BARBARA BUSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6622 N 91ST AVE STE 230
GLENDALE AZ
85305-2570
US

IV. Provider business mailing address

5445 DTC PKWY STE 1130
GREENWOOD VILLAGE CO
80111-3038
US

V. Phone/Fax

Practice location:
  • Phone: 602-325-2024
  • Fax: 720-925-5897
Mailing address:
  • Phone: 720-749-5599
  • Fax: 720-925-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-033340
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: