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NPI Code Detail

MEDICARE: MS. RHONDA MICHELLE BUSH PTA

MEDICARE: MS. RHONDA MICHELLE BUSH PTA
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
1225200000XPhysical Therapy AssistantPTA2817MS

General Provider Information

NPI Number : 1841766052
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RHONDA MICHELLE BUSH PTA
Provider Business Mailing Address
First Line : PO BOX 457
Second Line :
City : MONTICELLO
State : MS
Zip : 39654-0457
Country : US
Telephone Number : 601-587-2563
Fax Number :
Provider Business Practice Location Address
First Line : 217 METHODIST BLVD
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-1338
Country : US
Telephone Number : 601-329-2233
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2018
Last Update Date : 10/16/2018

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