Provider Demographics
NPI:1164307997
Name:BUSH, LEA R
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:R
Last Name:BUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 SUN LILY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8099
Mailing Address - Country:US
Mailing Address - Phone:904-710-3854
Mailing Address - Fax:
Practice Address - Street 1:14600 WHIRLWIND AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9437
Practice Address - Country:US
Practice Address - Phone:904-447-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No253Z00000XAgenciesIn Home Supportive Care