Healthcare Provider Details

I. General information

NPI: 1235060799
Provider Name (Legal Business Name): BAILEY RUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY MILLER

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SAGAMORE PKWY W STE 917
WEST LAFAYETTE IN
47906-1443
US

IV. Provider business mailing address

PO BOX 781008
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-0710
  • Fax: 765-463-0711
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06007082A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: