Provider Demographics
NPI:1598977993
Name:RUSH SHUMPERT, PAULA JO (DT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JO
Last Name:RUSH SHUMPERT
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 SCHWARZ MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6709
Mailing Address - Country:US
Mailing Address - Phone:618-550-8898
Mailing Address - Fax:
Practice Address - Street 1:2661 N ILLINOIS ST STE 126
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2302
Practice Address - Country:US
Practice Address - Phone:618-550-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist