Individual
MARY BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
831 PINE BEACH RD, MARINETTE, WI 54143-4225
(715) 732-5796
Mailing address
N1961 SHORE DR, MARINETTE, WI 54143-9213
(715) 735-3982
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
553-19
WI
Other
Enumeration date
08/21/2006
Last updated
07/08/2007
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