Provider Demographics
NPI:1063146132
Name:RUSH, SEAN D (DPR)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:RUSH
Suffix:
Gender:M
Credentials:DPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 ATWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3262
Mailing Address - Country:US
Mailing Address - Phone:401-351-0515
Mailing Address - Fax:
Practice Address - Street 1:1539 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3262
Practice Address - Country:US
Practice Address - Phone:401-351-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT03523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist