Provider Demographics
NPI:1548501729
Name:GAZ BUSHNO, IRENE (MPT)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:GAZ BUSHNO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:GAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:253 FOXCROFT DR E
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5612
Mailing Address - Country:US
Mailing Address - Phone:407-376-2699
Mailing Address - Fax:
Practice Address - Street 1:253 FOXCROFT DR E
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5612
Practice Address - Country:US
Practice Address - Phone:407-376-2699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 20178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist