Provider Demographics
NPI:1932295979
Name:RUDNICK, DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12525 EAST MISSION
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1079
Mailing Address - Country:US
Mailing Address - Phone:509-928-1500
Mailing Address - Fax:509-928-8006
Practice Address - Street 1:12525 EAST MISSION
Practice Address - Street 2:SUITE 104
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1079
Practice Address - Country:US
Practice Address - Phone:509-928-1500
Practice Address - Fax:509-928-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8336026Medicaid
AB15868Medicare ID - Type Unspecified
WA8336026Medicaid