Healthcare Provider Details

I. General information

NPI: 1861575367
Provider Name (Legal Business Name): AMARA RUSHING LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 INGRAM STREET SUITE B
CLINTON AR
72031
US

IV. Provider business mailing address

119 INGRAM STREET SUITE B
CLINTON AR
72031
US

V. Phone/Fax

Practice location:
  • Phone: 501-745-8881
  • Fax: 501-745-3113
Mailing address:
  • Phone: 501-745-8881
  • Fax: 501-745-3113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA1916
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: