MEDICARE: SCOTT NICHOLAS RUSE DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	05013033A	IN

General Provider Information

NPI Number	:	1558849000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT NICHOLAS RUSE DPT

Provider Business Mailing Address
First Line	:	4251 LAHMEYER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5676
Country	:	US
Telephone Number	:	260-432-4700
Fax Number	:	260-459-9262

Provider Business Practice Location Address
First Line	:	3300 LAKE CITY HWY
Second Line	:
City	:	WARSAW
State	:	IN
Zip	:	46580-3923
Country	:	US
Telephone Number	:	574-306-2912
Fax Number	:	574-306-2922

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2018
Last Update Date	:	08/06/2018

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Directions to “ SCOTT NICHOLAS RUSE DPT” Practice Location

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