Provider Demographics
NPI:1851131015
Name:BUSH, ALYSSA MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ALYSSA
Middle Name:MARIE
Last Name:BUSH
Suffix:
Gender:F
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 1:1015 HATCHES POND LN APT 404
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6445
Mailing Address - Country:US
Mailing Address - Phone:518-491-8831
Mailing Address - Fax:
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-684-2445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP23192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist