David Ismael Silva Bustamante, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

61510432 Issued in AZ

Practice address

17020 Twin Lakes Ave Ste C101
Marysville, WA 98271-4731

Phone

(360) 658-8400

NPI assigned

Feb 12, 2024

Last updated

Feb 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707696000000",
    "number": "1811751696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 BASELINE RD",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864427026",
            "telephone_number": "928-542-2283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17020 TWIN LAKES AVE STE C101",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982714731",
            "telephone_number": "360-658-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SILVA BUSTAMANTE",
        "first_name": "DAVID",
        "middle_name": "ISMAEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AZ",
            "license": "61510432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul F Shoup
• Denise Shushan, M.D.
• Arminder K Sidhu
• Manuel Enrique Sierra Ascencio
• Rain Sigler
• Anitha Simon
• Maria Simon
• Kimberly Singletary, L.M.T.
• Alesia Skinner
• Hannah Nicole Skinner, OTD

• Physical Therapy Assistant in Marysville, WA
• Providers in Marysville, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.