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General NPI Number Information
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NPI Number | 1326769357
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Entity Type | Individual
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Provider Name | AMANDA RAE RUDD DPT
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Gender | Female
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 14800 W SAINT TERESA ST
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City | WICHITA
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State | KS
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Zip | 67235-9602
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Country | US
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Telephone | 316-796-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 1911 N MINNEAPOLIS CIR
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City | VALLEY CENTER
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State | KS
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Zip | 67147-8630
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Country | US
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Telephone | 316-734-7152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-05453
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License Number State | KS
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