Healthcare Provider Details

I. General information

NPI: 1831690395
Provider Name (Legal Business Name): TRUDE RODLI-CULVER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3394 E JOLLY RD STE B
LANSING MI
48910-8595
US

IV. Provider business mailing address

5599 WOOD VALLEY DR
HASLETT MI
48840-9714
US

V. Phone/Fax

Practice location:
  • Phone: 517-975-3520
  • Fax:
Mailing address:
  • Phone: 517-290-1103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: