Provider Demographics
NPI:1144374083
Name:RUSH, LAURIE (PT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:RUSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 LANCEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-5026
Mailing Address - Country:US
Mailing Address - Phone:432-368-4980
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR STE 7
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4243
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:432-335-8787
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1051530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist