Provider Demographics
NPI:1437115425
Name:RUDD, LEMUEL DALE (PT)
Entity type:Individual
Prefix:MR
First Name:LEMUEL
Middle Name:DALE
Last Name:RUDD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-681-2520
Mailing Address - Fax:
Practice Address - Street 1:124 B W SPRUCE
Practice Address - Street 2:SEQUIM PHYSICAL THERAPY CTR PS
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-0632
Practice Address - Fax:360-681-8453
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPR00002822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOD64457OtherL & I IND
WA8106WIOtherREGENCE
WA8355133Medicaid
P00017905OtherRAILROAD MEDICARE IND
WA7117260Medicaid
DA1273OtherRAILROAD MEDICARE GRP
81061006701OtherKPS
WA0173768OtherWORKMAN'S COMP GRP
WA0173768OtherWORKMAN'S COMP GRP
WAGAB37225Medicare ID - Type UnspecifiedGRP