Provider Demographics
NPI:1902297898
Name:BUSH, ALDEA FAY (ATC)
Entity Type:Individual
Prefix:MISS
First Name:ALDEA
Middle Name:FAY
Last Name:BUSH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 BILTMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4612
Mailing Address - Country:US
Mailing Address - Phone:828-884-8272
Mailing Address - Fax:828-884-8274
Practice Address - Street 1:534 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4612
Practice Address - Country:US
Practice Address - Phone:828-884-8272
Practice Address - Fax:828-884-8274
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer