Healthcare Provider Details

I. General information

NPI: 1467116822
Provider Name (Legal Business Name): MARTIN BUSCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 E CHEYENNE MOUNTAIN BLVD STE N
COLORADO SPRINGS CO
80906-3769
US

IV. Provider business mailing address

202 E CHEYENNE MOUNTAIN BLVD STE N
COLORADO SPRINGS CO
80906-3769
US

V. Phone/Fax

Practice location:
  • Phone: 719-527-9331
  • Fax: 719-527-9372
Mailing address:
  • Phone: 719-527-9331
  • Fax: 719-527-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL.0017978
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: