Provider Demographics
NPI:1396228375
Name:RUDENGA, ALEXANDRA R (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:R
Last Name:RUDENGA
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 1:905 N ORLEANS ST UNIT 1212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3032
Mailing Address - Country:US
Mailing Address - Phone:716-397-7636
Mailing Address - Fax:
Practice Address - Street 1:3228 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1602
Practice Address - Country:US
Practice Address - Phone:716-397-7636
Practice Address - Fax:833-243-0445
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070023756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist