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Individual
JENNIFER C RUDOLPH
Active
Individual
JENNIFER C RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT017208
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032552020028
—
PA
01
—
774255
MEDICARE
PA
Enumeration date
07/09/2010
Last updated
04/29/2020
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