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General NPI Number Information
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NPI Number | 1750445508
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Entity Type | Individual
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Provider Name | ANN THERESA RUDAT AUD
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Gender | Female
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1585 3RD ST BJACH EENT CLINIC
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City | FT. POLK
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State | LA
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Zip | 71459
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Country | US
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Telephone | 337-531-3297
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Fax | 337-531-3290
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Provider Business Mailing Address
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Address Line | 7572 KURTHWOOD RD
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City | LEESVILLE
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State | LA
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Zip | 71446
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Country | US
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Telephone |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AT001159-L
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License Number State | PA
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