Provider Demographics
NPI:1740484021
Name:RUDMAN, JOSHUA (PT)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:RUDMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 MAIN ST
Mailing Address - Street 2:APT 8H
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8327
Mailing Address - Country:US
Mailing Address - Phone:603-219-8882
Mailing Address - Fax:
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-847-0193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040-0003721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist