Provider Demographics
NPI:1649675018
Name:MEHL-RUDD, MONA MARGARET (MS PT)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:MARGARET
Last Name:MEHL-RUDD
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1643 STILL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2389
Mailing Address - Country:US
Mailing Address - Phone:636-541-1822
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:35 SUGAR MAPLE LN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5740
Practice Address - Country:US
Practice Address - Phone:636-946-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007008448225100000X
FL32714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist