Provider Demographics
NPI:1366433427
Name:RUSH, BECKY J (PT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:J
Last Name:RUSH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MALCOLM AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-7628
Mailing Address - Country:US
Mailing Address - Phone:870-523-6500
Mailing Address - Fax:870-523-6508
Practice Address - Street 1:801 MALCOLM AVENUE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-7211
Practice Address - Country:US
Practice Address - Phone:870-523-6500
Practice Address - Fax:870-523-6508
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR133317721Medicaid