Provider Demographics
NPI:1275372245
Name:BUSSEY, DEREK (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NORTHUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17857-9759
Mailing Address - Country:US
Mailing Address - Phone:570-490-1832
Mailing Address - Fax:
Practice Address - Street 1:666 ALLEGHENY RIVER BLVD STE B
Practice Address - Street 2:
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1535
Practice Address - Country:US
Practice Address - Phone:412-265-4236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist