Provider Demographics
NPI:1174728877
Name:BUSHARD, JODILYNN MARIE (CMT)
Entity type:Individual
Prefix:MS
First Name:JODILYNN
Middle Name:MARIE
Last Name:BUSHARD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14115 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-5719
Mailing Address - Country:US
Mailing Address - Phone:612-859-5548
Mailing Address - Fax:
Practice Address - Street 1:14501 GRANADA DRIVE SUITE 101
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-4506
Practice Address - Country:US
Practice Address - Phone:952-431-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist