Healthcare Provider Details

I. General information

NPI: 1134405509
Provider Name (Legal Business Name): AMY R BUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY R OLSON

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 MAIN ST. NE #101
DUVALL WA
98019
US

IV. Provider business mailing address

17618 140TH AVE NE
WOODINVILLE WA
98072
US

V. Phone/Fax

Practice location:
  • Phone: 425-788-0505
  • Fax: 425-788-3340
Mailing address:
  • Phone: 425-402-9772
  • Fax: 425-402-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: