MEDICARE: ALEXANDRA R RUDENGA DPT

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	225100000X	Physical Therapist	070023756	IL

General Provider Information

NPI Number	:	1396228375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRA R RUDENGA DPT

Provider Business Mailing Address
First Line	:	905 N ORLEANS ST UNIT 1212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-3032
Country	:	US
Telephone Number	:	716-397-7636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1602
Country	:	US
Telephone Number	:	716-397-7636
Fax Number	:	833-243-0445

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

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	04/08/2021

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