MEDICARE: MARGARET MARY RUDIS PT

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	5501003254	MI

General Provider Information

NPI Number	:	1639353717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET MARY RUDIS PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33566 W 8 MILE RD
Second Line	:
City	:	FARMINGTON
State	:	MI
Zip	:	48335-5271
Country	:	US
Telephone Number	:	248-478-7330
Fax Number	:	248-478-4352

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

Provider Enumeration Date	:	12/24/2007
Last Update Date	:	06/13/2014

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