Provider Demographics
NPI:1871161778
Name:RUD, MEGHAN ALEXANDRIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ALEXANDRIA
Last Name:RUD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 VICKERY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4403
Mailing Address - Country:US
Mailing Address - Phone:770-709-8397
Mailing Address - Fax:
Practice Address - Street 1:4800 OLDE TOWNE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4378
Practice Address - Country:US
Practice Address - Phone:770-485-3045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist