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General NPI Number Information
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NPI Number | 1801619929
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Entity Type | Individual
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Provider Name | SIDNEY AVAN RUDD PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 315 W 5TH ST STE 200
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City | BENTON
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State | KY
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Zip | 42025-1152
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Country | US
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Telephone | 270-252-7200
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Fax | 270-252-7201
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Provider Business Mailing Address
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Address Line | 1489 OAK LEVEL RD
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City | BENTON
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State | KY
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Zip | 42025-5354
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Country | US
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Telephone | 270-205-0313
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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 | 009233
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License Number State | KY
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