Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1246459 | TX |
Y | 225CA2400X | Assistive Technology Practitioner | 89139 | TX |
NPI | 1588144067 |
---|---|
Provider Name | Catherine Bussey |
First Address | Fort Worth, TX 76199-1383 |
Second Address | Fort Worth, TX 76104-1025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/04/2021 |