Provider Demographics
NPI:1023472917
Name:RUDOLPH, ASHLEY (MS, ATC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N 44TH ST
Mailing Address - Street 2:APT 802
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL STADIUM DR
Practice Address - Street 2:ATHLETIC MEDICINE
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68588-0031
Practice Address - Country:US
Practice Address - Phone:402-472-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer