Healthcare Provider Details

I. General information

NPI: 1760614671
Provider Name (Legal Business Name): JANICE PRESTON RUSH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANICE BLAIR PRESTON

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

IV. Provider business mailing address

215 DUNBAR CAVE RD STE A
CLARKSVILLE TN
37043-8850
US

V. Phone/Fax

Practice location:
  • Phone: 931-542-2739
  • Fax: 931-233-9970
Mailing address:
  • Phone: 931-542-2739
  • Fax: 931-233-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number10216
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: