Provider Demographics
NPI:1063635019
Name:BRUSH, ERIC NEIL (LMT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:NEIL
Last Name:BRUSH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-5924
Mailing Address - Country:US
Mailing Address - Phone:319-341-8110
Mailing Address - Fax:
Practice Address - Street 1:1120 N GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-5924
Practice Address - Country:US
Practice Address - Phone:319-341-8110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02744225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist