Provider Demographics
NPI:1609181403
Name:RUDD, DARIN A (LMT)
Entity Type:Individual
Prefix:
First Name:DARIN
Middle Name:A
Last Name:RUDD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1094 S GILBERT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3445
Mailing Address - Country:US
Mailing Address - Phone:480-247-0926
Mailing Address - Fax:480-632-1982
Practice Address - Street 1:1094 S GILBERT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3445
Practice Address - Country:US
Practice Address - Phone:480-247-0926
Practice Address - Fax:480-632-1982
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-03927P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist