Provider Demographics
NPI:1487038352
Name:RUSH, JARED (ATC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 BLUEBELL CT
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-7728
Mailing Address - Country:US
Mailing Address - Phone:937-474-8026
Mailing Address - Fax:
Practice Address - Street 1:315 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW MADISON
Practice Address - State:OH
Practice Address - Zip Code:45346-9797
Practice Address - Country:US
Practice Address - Phone:937-474-8026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer