Provider Demographics
NPI:1992017263
Name:RUDEWICK, ROY (ATC)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:RUDEWICK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-2330
Mailing Address - Country:US
Mailing Address - Phone:817-272-2265
Mailing Address - Fax:817-272-7388
Practice Address - Street 1:1309 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2330
Practice Address - Country:US
Practice Address - Phone:817-272-2265
Practice Address - Fax:817-272-7388
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT1095208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation