MEDICARE: NED B BUSHNELL PT

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	225100000X	Physical Therapist	115470-2401	UT

General Provider Information

NPI Number	:	1528050861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NED B BUSHNELL PT

Provider Business Mailing Address
First Line	:	1067 N 500 W BLDG B
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-370-9981
Fax Number	:	801-370-9984

Provider Business Practice Location Address
First Line	:	1067 N 500 W BLDG B
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3305
Country	:	US
Telephone Number	:	801-370-9981
Fax Number	:	801-370-9984

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/26/2010

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