Individual
GREY RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2500 E PROSPECT, FORT COLLINS, CO 80525-9718
(970) 493-0112
Mailing address
2500 E PROSPECT, FORT COLLINS, CO 80525-9718
(970) 493-0112
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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