Provider Demographics
NPI:1235837287
Name:RUDA, AMANDA RAE (PTA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:RUDA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14296 WILDFLOWER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-9103
Mailing Address - Country:US
Mailing Address - Phone:308-520-1122
Mailing Address - Fax:
Practice Address - Street 1:690 SUNSET BLVD N STE 108
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-5610
Practice Address - Country:US
Practice Address - Phone:910-575-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant