Provider Demographics
NPI:1982078374
Name:RUSHING, ANTONIO (MA60582370)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:RUSHING
Suffix:
Gender:M
Credentials:MA60582370
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6148 SW OLD CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-7422
Mailing Address - Country:US
Mailing Address - Phone:509-499-8717
Mailing Address - Fax:
Practice Address - Street 1:1007 SCOTT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4874
Practice Address - Country:US
Practice Address - Phone:360-405-0293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60582370225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist