Provider Demographics
NPI:1659526697
Name:RUDDER, SHEREE ANN (PTA)
Entity Type:Individual
Prefix:MS
First Name:SHEREE
Middle Name:ANN
Last Name:RUDDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EDGEWORTH RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6916
Mailing Address - Country:US
Mailing Address - Phone:678-416-2276
Mailing Address - Fax:
Practice Address - Street 1:110 EDGEWORTH RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6916
Practice Address - Country:US
Practice Address - Phone:678-416-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant