MEDICARE: ELIZABETH RUDOLPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	9942	NV

General Provider Information

NPI Number	:	1194324707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RUDOLPH

Provider Business Mailing Address
First Line	:	10508 HARVEST WIND DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-4015
Country	:	US
Telephone Number	:	949-793-1056
Fax Number	:

Provider Business Practice Location Address
First Line	:	5568 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-3602
Country	:	US
Telephone Number	:	949-793-1056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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Directions to “ ELIZABETH RUDOLPH ” Practice Location

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