Provider Demographics
NPI:1588418107
Name:DIANA RUSH LMP
Entity type:Organization
Organization Name:DIANA RUSH LMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:360-481-2347
Mailing Address - Street 1:PO BOX 755
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-0755
Mailing Address - Country:US
Mailing Address - Phone:360-481-2347
Mailing Address - Fax:
Practice Address - Street 1:7517 CUSTER RD W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-8138
Practice Address - Country:US
Practice Address - Phone:360-481-2347
Practice Address - Fax:360-539-8535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty