Individual
MISS CAROLINE BRINSON BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
960 S BROADWAY AVE, BOISE, ID 83706-3600
(208) 433-9211
Mailing address
6243 S WAYLAND WAY, MERIDIAN, ID 83642-5711
(901) 786-2761
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-7147
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PTA-7147
—
ID
Enumeration date
06/07/2021
Last updated
06/07/2021
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