Healthcare Provider Details

I. General information

NPI: 1164120309
Provider Name (Legal Business Name): BRACKEN R BUSSCHER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date: 08/30/2026
Reactivation Date: 09/09/2026

III. Provider practice location address

900 W WESTERN AVE
MUSKEGON MI
49441-1617
US

IV. Provider business mailing address

1348 LAKESHORE DR
MUSKEGON MI
49441-1651
US

V. Phone/Fax

Practice location:
  • Phone: 616-847-1280
  • Fax:
Mailing address:
  • Phone: 616-335-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: