MEDICARE: DR. MATTHEW LANE BUSH P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	010666	GA
2	225100000X	Physical Therapist	010666	GA

General Provider Information

NPI Number	:	1447696661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW LANE BUSH P.T.

Provider Business Mailing Address
First Line	:	350 CRAG RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-7013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 CRAG RD
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-7013
Country	:	US
Telephone Number	:	912-657-1121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	07/25/2025

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