1437115425 NPI number — MR. LEMUEL DALE RUDD PT

Table of content: C SCOTT THOMPSON DO (NPI 1659308419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437115425 NPI number — MR. LEMUEL DALE RUDD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUDD
Provider First Name:
LEMUEL
Provider Middle Name:
DALE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437115425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 RESERVOIR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEQUIM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-681-2520
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 B W SPRUCE
Provider Second Line Business Practice Location Address:
SEQUIM PHYSICAL THERAPY CTR PS
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-0632
Provider Business Practice Location Address Fax Number:
360-681-8453
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PR00002822 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: OD64457 . This is a "L & I IND" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8106WI . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8355133 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00017905 . This is a "RAILROAD MEDICARE IND" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7117260 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA1273 . This is a "RAILROAD MEDICARE GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81061006701 . This is a "KPS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0173768 . This is a "WORKMAN'S COMP GRP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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