Provider Demographics
NPI:1407989023
Name:RUSH, BRENDA K (PTA)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:RUSH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 LONGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3534
Mailing Address - Country:US
Mailing Address - Phone:610-489-3915
Mailing Address - Fax:
Practice Address - Street 1:2849 BIG ROAD.
Practice Address - Street 2:ROUTE 73
Practice Address - City:FREDERICK
Practice Address - State:PA
Practice Address - Zip Code:19435
Practice Address - Country:US
Practice Address - Phone:610-754-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000334L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant