Provider Demographics
NPI:1457347759
Name:RUDY, MAUREEN A (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:RUDY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:A
Other - Last Name:MOLNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:261 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ANNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17003-9061
Mailing Address - Country:US
Mailing Address - Phone:717-838-0193
Mailing Address - Fax:
Practice Address - Street 1:93 DOE RUN RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-8560
Practice Address - Country:US
Practice Address - Phone:717-664-4980
Practice Address - Fax:717-664-4981
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT002741E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA156372OtherHIGHMARK BLUE SHIELD
PAS41513OtherHEALTHAMERICA/HEALTHASSUR
PA01659001OtherCAPITAL BLUE CROSS
PA253368OtherMAMSI HEALTH PLAN
PA01659001OtherCAPITAL BLUE CROSS
PA156372LHTMedicare ID - Type Unspecified