Healthcare Provider Details

I. General information

NPI: 1558849000
Provider Name (Legal Business Name): SCOTT NICHOLAS RUSE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 08/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 LAKE CITY HWY
WARSAW IN
46580-3923
US

IV. Provider business mailing address

4251 LAHMEYER RD
FORT WAYNE IN
46815-5676
US

V. Phone/Fax

Practice location:
  • Phone: 574-306-2912
  • Fax: 574-306-2922
Mailing address:
  • Phone: 260-432-4700
  • Fax: 260-459-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013033A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: