Active NPI
Mary Beth Bush, PT
- Physical Therapist
- Glen Ellyn, IL
National Provider Identifier
1508935081
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070.004653
- Practice address
- 875 Roosevelt Rd
Glen Ellyn, IL 60137-6101 - Phone
- (630) 469-7858
- Fax
- (630) 469-0098
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.004653 | IL | Primary |
Addresses
Primary practice location
875 Roosevelt Rd
Glen Ellyn, IL 60137-6101
Mailing address
334 Greenfield Ave
Glen Ellyn, IL 60137-5337
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.004653 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162857600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1249516800000",
"number": "1508935081",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "334 GREENFIELD AVE",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601375337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "875 ROOSEVELT RD",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601376101",
"telephone_number": "630-469-7858",
"fax_number": "630-469-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "MARY",
"middle_name": "BETH",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-07",
"last_updated": "2009-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.004653",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.