Individual
CARLI BUSHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1464 LINCOLNWAY S, LIGONIER, IN 46767-9601
(260) 248-9966
(260) 894-3171
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06004846A
IN
Other
Enumeration date
03/13/2020
Last updated
11/02/2020
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