Individual
LOGAN BUSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
9210 S WESTERN AVE STE 27, OKLAHOMA CITY, OK 73139-2734
(405) 692-6333
Mailing address
1044 SHADOWLAKE RD, NORMAN, OK 73071-6877
(918) 457-7521
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3857
OK
Other
Enumeration date
10/23/2024
Last updated
10/23/2024
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