Healthcare Provider Details

I. General information

NPI: 1164516241
Provider Name (Legal Business Name): CHERYL A BUSBY P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31545 HIGHWAY 22 STE A
SPRINGFIELD LA
70462-7405
US

IV. Provider business mailing address

PO BOX 184
SPRINGFIELD LA
70462-0184
US

V. Phone/Fax

Practice location:
  • Phone: 225-414-0550
  • Fax: 225-228-4256
Mailing address:
  • Phone: 225-414-0550
  • Fax: 225-228-4256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT03894
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: