Provider Demographics
NPI:1326769357
Name:RUDD, AMANDA RAE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:RAE
Last Name:RUDD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N MINNEAPOLIS CIR
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67147-8630
Mailing Address - Country:US
Mailing Address - Phone:316-734-7152
Mailing Address - Fax:
Practice Address - Street 1:14800 W SAINT TERESA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9602
Practice Address - Country:US
Practice Address - Phone:316-796-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
KS11-05453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist