Basic Information
| Provider Information | |||||||||
| NPI: | 1245561398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUDOLPHI | ||||||||
| FirstName: | TARA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1140 NOLAN CT | ||||||||
| Address2: | |||||||||
| City: | NORTH LIBERTY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523174700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633578399 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 502 WEST ST | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSBURG | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523619681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633578399 | ||||||||
| FaxNumber: | 3198530983 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2010 | ||||||||
| LastUpdateDate: | 04/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 004481 | IA | N | Other Service Providers | Specialist | 225100000X | 004481 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.