Provider Demographics
NPI:1033158761
Name:RUDH JONES, VICKI LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:LYNN
Last Name:RUDH JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:LYNN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:283 OSPREY RDG
Mailing Address - Street 2:
Mailing Address - City:MACHESNEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61115-8364
Mailing Address - Country:US
Mailing Address - Phone:815-623-9200
Mailing Address - Fax:815-623-9200
Practice Address - Street 1:283 OSPREY RDG
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-8364
Practice Address - Country:US
Practice Address - Phone:815-623-9200
Practice Address - Fax:815-623-9200
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070010001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10132018OtherBCBS OF IL