MEDICARE: MR. DAVID RUDNICK 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	PT00003603	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932295979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID RUDNICK PT

Provider Business Mailing Address
First Line	:	12525 EAST MISSION
Second Line	:	SUITE 104
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

Provider Business Practice Location Address
First Line	:	12525 EAST MISSION
Second Line	:	SUITE 104
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1079
Country	:	US
Telephone Number	:	509-928-1500
Fax Number	:	509-928-8006

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/25/2010

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Directions to “ MR. DAVID RUDNICK PT” Practice Location

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