Provider Demographics
NPI:1487260899
Name:RUDD, KIMBERLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RUDD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:RUDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S 31ST AVE APT 4206
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1407
Mailing Address - Country:US
Mailing Address - Phone:208-841-3131
Mailing Address - Fax:
Practice Address - Street 1:17055 FRANCES ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4655
Practice Address - Country:US
Practice Address - Phone:402-280-3555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4143225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist