Basic Information
Provider Information
NPI: 1982070470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUSHING
FirstName: ROBERT
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 305 NE LOOP 820
Address2: TOWER 1, SUITE 200
City: HURST
State: TX
PostalCode: 760537209
CountryCode: US
TelephoneNumber: 8172928787
FaxNumber: 8177896849
Practice Location
Address1: 87 I-10 N
Address2: SUITE 225
City: BEAUMONT
State: TX
PostalCode: 77707
CountryCode: US
TelephoneNumber: 4098350228
FaxNumber: 4098350151
Other Information
ProviderEnumerationDate: 08/19/2015
LastUpdateDate: 08/19/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2355S0801X35220TXY Speech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant

No ID Information.


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