Provider Demographics
NPI:1245088145
Name:RUSHING, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:RUSHING
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 1:237 BRITTONS FARM DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-1427
Mailing Address - Country:US
Mailing Address - Phone:910-734-4497
Mailing Address - Fax:
Practice Address - Street 1:237 BRITTONS FARM DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-1427
Practice Address - Country:US
Practice Address - Phone:910-734-4497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist