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Individual
KELLY LEE BUSHORE
Active
Individual
KELLY LEE BUSHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
DAPT000019
PA
225100000X
Physical Therapist
PT015724
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1438404
HIGHMARK
PA
Enumeration date
11/23/2005
Last updated
07/13/2026
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