Provider Demographics
NPI:1427557834
Name:RUDD, TERRY LINZY (ND LAC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LINZY
Last Name:RUDD
Suffix:
Gender:M
Credentials:ND LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 VAN TASSEL ST APT B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1740
Mailing Address - Country:US
Mailing Address - Phone:806-803-0069
Mailing Address - Fax:
Practice Address - Street 1:3503 VAN TASSEL ST APT B
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121-1740
Practice Address - Country:US
Practice Address - Phone:806-803-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1097171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist