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General NPI Number Information
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NPI Number | 1588529309
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Entity Type | Individual
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Provider Name | SAMUEL BUSHONG DPT, PT
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Gender | Male
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 375 E HORSETOOTH RD STE 104
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City | FORT COLLINS
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State | CO
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Zip | 80525-3155
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Country | US
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Telephone | 970-286-2868
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Fax |
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Provider Business Mailing Address
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Address Line | 3733 PRECISION DR # D-327
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City | FORT COLLINS
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State | CO
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Zip | 80528-4553
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Country | US
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Telephone | 480-251-7650
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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