Healthcare Provider Details

I. General information

NPI: 1952508335
Provider Name (Legal Business Name): RICKY L BUSSEY JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W 15TH ST
WAHOO NE
68066-1280
US

IV. Provider business mailing address

4731 S 153RD CT
OMAHA NE
68137-5025
US

V. Phone/Fax

Practice location:
  • Phone: 402-443-4555
  • Fax: 402-443-4554
Mailing address:
  • Phone: 402-316-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2693
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: