Individual
AMY RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10000 W 75TH ST, SUITE 250, MERRIAM, KS 66204-2209
(913) 894-1910
Mailing address
21117 E 50TH TERRACE DR S, BLUE SPRINGS, MO 64015-2257
(816) 229-3902
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
105449
MO
225100000X
Physical Therapist
11-01867
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105449
MISSOURI STATE BOARD OF REGISTRATION FOR THE HEALING ARTS
MO
01
—
11-01867
KANSAS STATE BOARD OF HEALING ARTS
KS
Enumeration date
01/22/2009
Last updated
01/22/2009
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