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General NPI Number Information
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NPI Number | 1336290238
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Entity Type | Individual
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Provider Name | SUSAN LOUGH RUDOLF P.T.
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 401 GILFORD AVE UNIT 240
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City | GILFORD
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State | NH
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Zip | 03249-7500
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Country | US
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Telephone | 603-528-4152
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Fax | 603-528-1591
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Provider Business Mailing Address
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Address Line | 44 ROCKY POINT DR
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City | BOW
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State | NH
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Zip | 03304-4112
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Country | US
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Telephone | 603-715-2062
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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 | 0518
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License Number State | NH
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