Provider Demographics
NPI:1346752193
Name:BUSH, DOLORES MARIA I (MSPT)
Entity type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:MARIA
Last Name:BUSH
Suffix:I
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23 PERTH DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2612
Mailing Address - Country:US
Mailing Address - Phone:302-545-2813
Mailing Address - Fax:302-658-3600
Practice Address - Street 1:750 SHIPYARD DR STE 100
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-5161
Practice Address - Country:US
Practice Address - Phone:302-658-3000
Practice Address - Fax:302-658-3600
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001051225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist