Provider Demographics
NPI:1790845907
Name:RUSH, IAIN (PTA)
Entity Type:Individual
Prefix:MR
First Name:IAIN
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
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:PO BOX 3405
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91729-3405
Mailing Address - Country:US
Mailing Address - Phone:909-920-6457
Mailing Address - Fax:909-920-9160
Practice Address - Street 1:400 N MOUNTAIN AVE STE 310
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5182
Practice Address - Country:US
Practice Address - Phone:909-920-6457
Practice Address - Fax:909-920-9160
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT4721225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant