Healthcare Provider Details

I. General information

NPI: 1356201156
Provider Name (Legal Business Name): PAITEN HALEY BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GOODLETTE-FRANK RD N
NAPLES FL
34102-5400
US

IV. Provider business mailing address

1315 AUTUMN OAKS DR
FRANKLIN KY
42134-1969
US

V. Phone/Fax

Practice location:
  • Phone: 270-647-2141
  • Fax:
Mailing address:
  • Phone: 270-647-2141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009442
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: