Basic Information
| Provider Information | |||||||||
| NPI: | 1326010109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDICH | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 148 EAST AVE | ||||||||
| Address2: | SUITE 2M | ||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068515721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038665454 | ||||||||
| FaxNumber: | 2033546182 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 CORPORATE DR | ||||||||
| Address2: | SUITE 233 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064846238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039245370 | ||||||||
| FaxNumber: | 2039245372 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 004470 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.