Provider Demographics
NPI:1770265126
Name:RUSHING, MALLORY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:RUSHING
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PEARCE RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-9353
Mailing Address - Country:US
Mailing Address - Phone:843-837-1930
Mailing Address - Fax:843-837-1931
Practice Address - Street 1:4 HAMPTON HALL BLVD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7812
Practice Address - Country:US
Practice Address - Phone:843-837-2930
Practice Address - Fax:843-837-1931
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist