Healthcare Provider Details

I. General information

NPI: 1992909212
Provider Name (Legal Business Name): KATHERINE B RUDD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6855 SHORE TER STE 100
INDIANAPOLIS IN
46254-4662
US

IV. Provider business mailing address

201 BERKSHIRE LN
NOBLESVILLE IN
46062-8456
US

V. Phone/Fax

Practice location:
  • Phone: 317-241-3200
  • Fax: 317-241-2535
Mailing address:
  • Phone: 317-877-9077
  • Fax: 317-241-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number06001840A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: