Provider Demographics
NPI:1346594371
Name:WERTH-RUDOLPH, CARRIE A (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:WERTH-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 1:325 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-1272
Mailing Address - Country:US
Mailing Address - Phone:541-688-3353
Mailing Address - Fax:
Practice Address - Street 1:325 SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-1272
Practice Address - Country:US
Practice Address - Phone:541-688-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic