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Individual

STEPHEN PHILIP BUSHEE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ATC, LATC

Contact information

Practice address
BOSTON COLLEGE, CONTE FORUM-ROOM 124, CHESTNUT HILL, MA 01778
(617) 552-3009
(617) 552-9101
Mailing address
19 HEARTHSTONE CIRCLE, WAYLAND, MA 01778
(508) 655-3495
(617) 552-9101

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
250
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10350
NATA CERTIFICATION NUMBER
MA
01
215674
STATE SERIAL NUMBER
MA
01
250
STATE LICENSE NUMBER
MA
Enumeration date
10/03/2006
Last updated
07/08/2007
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