Healthcare Provider Details

I. General information

NPI: 1679482525
Provider Name (Legal Business Name): SERGEY RUDYAK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BEECHER LN
ROCKY HILL CT
06067-3237
US

IV. Provider business mailing address

12 BEECHER LN
ROCKY HILL CT
06067-3237
US

V. Phone/Fax

Practice location:
  • Phone: 860-218-3402
  • Fax:
Mailing address:
  • Phone: 860-218-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number002190
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: