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General NPI Number Information
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NPI Number | 1710907993
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Entity Type | Individual
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Provider Name | ROBERT G. BUSSE PT
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 06/25/2013
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Provider Practice Location Address
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Address Line | 2100 D. OMRO ROAD
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City | OSHKOSH
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State | WI
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Zip | 54904
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Country | US
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Telephone | 920-232-4040
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Fax | 920-232-4042
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Provider Business Mailing Address
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Address Line | 4000 N PROVIDENCE AVE
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City | APPLETON
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State | WI
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Zip | 54913-8018
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Country | US
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Telephone | 920-257-2009
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Fax | 920-257-2004
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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 | 3258-024
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License Number State | WI
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