Provider Demographics
NPI:1992398911
Name:CRUSH, EMMA GWYNN
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:GWYNN
Last Name:CRUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6708 WILD FOX LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9479
Mailing Address - Country:US
Mailing Address - Phone:502-810-4268
Mailing Address - Fax:
Practice Address - Street 1:6708 WILD FOX LN
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9479
Practice Address - Country:US
Practice Address - Phone:502-810-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer