Provider Demographics
NPI:1114015286
Name:RUDOLPH, CATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 RODMOR RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4539
Practice Address - Country:US
Practice Address - Phone:610-449-8400
Practice Address - Fax:610-449-6392
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2230038OtherFIRST HEALTH
NJ2378744OtherUNITEDHEALTHCARE MPIN
NJ2230038OtherFIRST HEALTH