Basic Information
| Provider Information | |||||||||
| NPI: | 1770601221 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUDIGER | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6903 OLD HIGHWAY 18 | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544829155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155926963 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 SHERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | STEVENS POINT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544817215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153441800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 05/29/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 6151 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 6151 | 01 | WI | WI LICENSE # | OTHER |