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General NPI Number Information
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NPI Number | 1477117604
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Entity Type | Individual
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Provider Name | PAIGE RUDEN ATC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 04/23/2019
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Provider Practice Location Address
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Address Line | 7001 W 56TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-9725
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Country | US
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Telephone | 443-758-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 229 SAINT ANTONS WAY
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City | ARNOLD
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State | MD
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Zip | 21012-1065
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Country | US
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Telephone | 443-758-5755
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1965
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License Number State | AL
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