Provider Demographics
NPI:1083121487
Name:RUDD, SHELBY ELIZABETH (ATC)
Entity Type:Individual
Prefix:MISS
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:RUDD
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1410
Mailing Address - Country:US
Mailing Address - Phone:859-620-8985
Mailing Address - Fax:
Practice Address - Street 1:310 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1410
Practice Address - Country:US
Practice Address - Phone:859-620-8985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer