Provider Demographics
NPI:1225558794
Name:TRUDO, JEFFREY B (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:B
Last Name:TRUDO
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W FOREST MEADOWS ST APT 154
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-2912
Mailing Address - Country:US
Mailing Address - Phone:802-825-1667
Mailing Address - Fax:
Practice Address - Street 1:492 EAST MCCONNELL DRIVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86011
Practice Address - Country:US
Practice Address - Phone:928-523-4151
Practice Address - Fax:928-523-8464
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer