Provider Demographics
NPI:1225895402
Name:RUDY, JULIE A (MA, ATC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:RUDY
Suffix:
Gender:F
Credentials:MA, ATC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATC
Mailing Address - Street 1:5259 BEAUMONT WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6975 MONTECITO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2787
Practice Address - Country:US
Practice Address - Phone:707-529-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer