Provider Demographics
NPI:1780380048
Name:RUDEBECK, TRENT (PT, DPT)
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:RUDEBECK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2219 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:ASPEN HILL
Practice Address - State:MD
Practice Address - Zip Code:20906-2204
Practice Address - Country:US
Practice Address - Phone:443-566-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-07
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist