Provider Demographics
NPI:1720343189
Name:BUSCHUR, ERIC JEFFREY (PT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JEFFREY
Last Name:BUSCHUR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3224 DAYTON XENIA RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-6481
Mailing Address - Country:US
Mailing Address - Phone:937-426-5555
Mailing Address - Fax:937-426-5556
Practice Address - Street 1:3224 DAYTON XENIA RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-6481
Practice Address - Country:US
Practice Address - Phone:937-426-5555
Practice Address - Fax:937-426-5556
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH117150Medicare Oscar/Certification