Healthcare Provider Details

I. General information

NPI: 1346692290
Provider Name (Legal Business Name): AMY ELIZABETH RUST PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY ELIZABETH CALAHAN ATC

II. Dates (important events)

Enumeration Date: 07/04/2016
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MONROE ST STE 300
PHOENIX AZ
85003-1718
US

IV. Provider business mailing address

111 W MONROE ST STE 300
PHOENIX AZ
85003-1718
US

V. Phone/Fax

Practice location:
  • Phone: 800-834-2420
  • Fax:
Mailing address:
  • Phone: 800-834-2420
  • Fax: 602-253-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6527
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1040
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: