Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT007869 | GA |
NPI | 1003141243 |
---|---|
Provider Name | Mrs. Stacy Leigh Rush |
First Address | Augusta, GA 30919-0039 |
Second Address | Augusta, GA 30909-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2009 |
Last Update Date | 06/10/2009 |