Individual
HOLLY RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1900 N PARK AVE, HERRIN, IL 62948-2742
(618) 942-2525
Mailing address
8210 TUNNEL HILL RD, GOREVILLE, IL 62939-2818
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160007391
IL
Other
Enumeration date
09/23/2021
Last updated
09/29/2021
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