Provider Demographics
NPI:1457672230
Name:RUSH, DUSTIN L (MAT, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:L
Last Name:RUSH
Suffix:
Gender:M
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 UTICA AVE
Mailing Address - Street 2:APT 502
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424
Mailing Address - Country:US
Mailing Address - Phone:806-787-1829
Mailing Address - Fax:806-795-0986
Practice Address - Street 1:7001 UTICA AVE
Practice Address - Street 2:APT. 502
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1600
Practice Address - Country:US
Practice Address - Phone:806-787-1829
Practice Address - Fax:806-795-0986
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT47702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer