MEDICARE: LEAH RUSHIN

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	208000000X	Pediatrics Physician	99867	TX
2	208000000X	Pediatrics Physician	99867	GA

General Provider Information

NPI Number	:	1568041093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH RUSHIN

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	817-793-8662
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 8TH AVE STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2619
Country	:	US
Telephone Number	:	817-336-7275
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	03/03/2026

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Directions to “ LEAH RUSHIN ” Practice Location

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