Individual
JORDAN M BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
400 SW 258TH ST, NEWBERRY, FL 32669-4112
(315) 777-1323
Mailing address
26761 LIMESTONE RD, REDWOOD, NY 13679-4184
(315) 777-1323
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL 4544
FL
Other
Enumeration date
07/11/2016
Last updated
07/11/2016
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