1043834898 NPI number — AMY C LUSH DPT

Table of content: AMY C LUSH DPT (NPI 1043834898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043834898 NPI number — AMY C LUSH DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUSH
Provider First Name:
AMY
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043834898
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140TH STREET STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-7052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-949-1274
Provider Business Mailing Address Fax Number:
360-470-7152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 SQUALICUM WAY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
350-949-1274
Provider Business Practice Location Address Fax Number:
360-470-7152
Provider Enumeration Date:
06/07/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT60794405 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT60794405 . This is a "PHYSICAL THERAPIST LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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