Individual
MRS. TABETHA L RUNDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
23830 COUNTY ROAD 48, LA SALLE, CO 80645-8612
(970) 451-1234
Mailing address
442 LAUREL AVE, EATON, CO 80615-9062
(970) 371-8892
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA.0012605
PTA LICENSE
CO
Enumeration date
12/11/2008
Last updated
10/25/2022
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