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General NPI Number Information
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NPI Number | 1558874487
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Entity Type | Individual
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Provider Name | DANIEL ROBERT RUDOLPH DPT
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Gender | Male
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 11/14/2017
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Provider Practice Location Address
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Address Line | 32261 CAMINO CAPISTRANO STE D101
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3747
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Country | US
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Telephone | 949-429-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 26571 NORMANDALE DR APT 17C
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City | LAKE FOREST
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State | CA
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Zip | 92630-6768
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Country | US
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Telephone | 732-232-7180
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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 | 294068
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License Number State | CA
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