MEDICARE: KEHAULANI ANNE RUSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	105628	FL

General Provider Information

NPI Number	:	1396693842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEHAULANI ANNE RUSH

Provider Business Mailing Address
First Line	:	50 KINGS LAKE BLVD
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-7096
Country	:	US
Telephone Number	:	714-813-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 KINGS LAKE BLVD
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-7096
Country	:	US
Telephone Number	:	714-813-7911
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “ KEHAULANI ANNE RUSH ” Practice Location

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