Healthcare Provider Details

I. General information

NPI: 1689584088
Provider Name (Legal Business Name): ELIZABETH RUDDY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1101 S RAISINVILLE RD
MONROE MI
48161-9047
US

IV. Provider business mailing address

8800 NEWCOMBE TRACE DR
TEMPERANCE MI
48182-8817
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-5799
  • Fax:
Mailing address:
  • Phone: 419-270-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number5501011327
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: