Provider Demographics
NPI:1336363522
Name:RUDE, KENNETH PAUL (PT)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:PAUL
Last Name:RUDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:RUDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-0490
Mailing Address - Country:US
Mailing Address - Phone:518-398-7506
Mailing Address - Fax:518-398-1143
Practice Address - Street 1:2980 E. CHURCHS STREET
Practice Address - Street 2:
Practice Address - City:PINE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12567
Practice Address - Country:US
Practice Address - Phone:518-398-7506
Practice Address - Fax:518-398-1143
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011180-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM9471Medicare ID - Type Unspecified