Marissa L Bush, D.P.T.
Individual provider Active NPI Pediatric Physical Therapist · Wayne, NJ
NPI 1558675397 · NPPES record last updated Jan 29, 2014
Key facts
- NPI
- 1558675397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Physical Therapist 2251P0200X
- License
- 40QA01360300 (NJ)
- Practice address
- 309 Black Oak Ridge Rd
Wayne, NJ 07470-6504 - Phone
- (973) 956-2900
- Fax
- (973) 956-7900
- NPI assigned
- Aug 4, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110401000552 | NJ | Practitioner - Physical Therapist in Private Practice | 9739363540 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40QA01360300 | NJ | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sportscare of America, PC | Pediatrics | Current |
Accepting new patients |
| Chiropractic Works, LLC | Current |
Accepting new patients | |
| United Sports Care & Physical Therapy | Pediatrics | Current |
Accepting new patients |
| Sportscare Institute, Inc. | Past |
Accepting new patients |
Locations
47 S Washington Ave
Bergenfield, NJ 07621
Phone (201) 384-2525
197 Ridgedale Ave
Cedar Knolls, NJ 07927
Phone (973) 292-0700
11 Eagle Rock Ave
Fl 2
East Hanover, NJ 07936
Phone (973) 887-3000
340 Ramapo Valley Rd
Oakland, NJ 07436
Phone (201) 644-0860
1 W Ridgewood Ave
Ste 104
Paramus, NJ 07652
Phone (201) 652-1415
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 40QA01360300 | NJ | Yes |
Addresses
Primary practice location
309 Black Oak Ridge Rd
Wayne, NJ 07470-6504
Mailing address
1 W Ridgewood Ave
Suite 104
Paramus, NJ 07652-2359
Phone (201) 652-1415
Other providers in Wayne, NJ
- Olufunke Buraimoh
- Cindy Ann Burns
- Les A Burns
- Alan Mark Burton
- Adam Busch
- Tracey L Byrne
- Socorro Caballery-Smith
- Onely Cabrera
- Luisa Cacciaguida
- John Joseph Callaghan
All providers in Wayne, NJ · Pediatric Physical Therapist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 29, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.