Provider Demographics
NPI:1215058268
Name:RUSK, JULIA ROSE
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:ROSE
Last Name:RUSK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N SEMINOLE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-2865
Mailing Address - Country:US
Mailing Address - Phone:260-760-7746
Mailing Address - Fax:260-456-7746
Practice Address - Street 1:226 N SEMINOLE CIR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-2865
Practice Address - Country:US
Practice Address - Phone:260-760-7746
Practice Address - Fax:260-456-7746
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist