Provider Demographics
NPI:1790917763
Name:RUDOWSKI, MICHAEL R
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:RUDOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 ANDREW JACKSON PKWY
Mailing Address - Street 2:VILLA-402
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2270
Mailing Address - Country:US
Mailing Address - Phone:615-612-7602
Mailing Address - Fax:
Practice Address - Street 1:4131 ANDREW JACKSON PKWY
Practice Address - Street 2:VILLA-402
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2270
Practice Address - Country:US
Practice Address - Phone:615-612-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT3444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist