Provider Demographics
NPI:1033372677
Name:RUDD, CHERYL LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:RUDD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1592 ROSE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-8763
Mailing Address - Country:US
Mailing Address - Phone:307-256-7128
Mailing Address - Fax:
Practice Address - Street 1:1620 SE SUMMIT CT
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5540
Practice Address - Country:US
Practice Address - Phone:509-332-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT 60018490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist