Individual
GREY RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8819
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74682261
—
CO
01
—
P00781111
RR MEDICARE
CO
Enumeration date
11/22/2005
Last updated
12/16/2019
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