Provider Demographics
NPI:1881921427
Name:RUDD, LAUREN C (PT)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:C
Last Name:RUDD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 LONE OAK RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-5752
Mailing Address - Country:US
Mailing Address - Phone:270-554-2883
Mailing Address - Fax:270-554-2885
Practice Address - Street 1:3530 LONE OAK RD
Practice Address - Street 2:SUITE C
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-5752
Practice Address - Country:US
Practice Address - Phone:270-554-2883
Practice Address - Fax:270-554-2885
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist