Provider Demographics
NPI:1053741256
Name:OVERLOCK, DENISE BUSH (PTA)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BUSH
Last Name:OVERLOCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 AVENUE H NE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4353
Mailing Address - Country:US
Mailing Address - Phone:863-291-6414
Mailing Address - Fax:
Practice Address - Street 1:1601 6TH ST SE
Practice Address - Street 2:SUITE B
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4605
Practice Address - Country:US
Practice Address - Phone:863-294-0350
Practice Address - Fax:863-294-0381
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA9272225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant