Healthcare Provider Details

I. General information

NPI: 1679051395
Provider Name (Legal Business Name): ZACHARY RUST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W BATTLEFIELD ST
SPRINGFIELD MO
65807-4123
US

IV. Provider business mailing address

607 W BATTLEFIELD ST
SPRINGFIELD MO
65807-4123
US

V. Phone/Fax

Practice location:
  • Phone: 417-869-2000
  • Fax: 417-881-1850
Mailing address:
  • Phone: 417-869-2000
  • Fax: 417-881-1850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2018028506
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: