Provider Demographics
NPI:1366041428
Name:BUSH, ELIZABETH (CPO)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BUSH
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7594 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3608
Mailing Address - Country:US
Mailing Address - Phone:804-643-9064
Mailing Address - Fax:804-643-8936
Practice Address - Street 1:7594 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-3608
Practice Address - Country:US
Practice Address - Phone:804-643-9064
Practice Address - Fax:804-643-8936
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist