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General NPI Number Information
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NPI Number | 1659683472
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Entity Type | Individual
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Provider Name | JENNIFER C RUDOLPH DPT
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Gender | Female
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Dates
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Enumeration Date | 07/09/2010
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 100 S FIRST STREET STE B
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City | MILLERSBURG
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State | PA
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Zip | 17061-1501
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Country | US
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Telephone | 717-692-4708
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Fax | 717-692-5464
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Provider Business Mailing Address
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Address Line | 7 DOCK HILL RD
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City | MIDDLEBURG
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State | PA
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Zip | 17842-8910
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Country | US
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Telephone | 570-837-2123
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Fax | 570-837-2185
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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 | PT017208
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License Number State | PA
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