Provider Demographics
NPI:1063500445
Name:PAUL, RUDY L (PT)
Entity Type:Individual
Prefix:
First Name:RUDY
Middle Name:L
Last Name:PAUL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 REGENTS PARK DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3081
Mailing Address - Country:US
Mailing Address - Phone:813-368-0398
Mailing Address - Fax:813-907-0731
Practice Address - Street 1:8905 REGENTS PARK DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3081
Practice Address - Country:US
Practice Address - Phone:813-368-0398
Practice Address - Fax:813-907-0731
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist