Provider Demographics
NPI:1083645691
Name:RUDAWSKY, ANDREW (MS, PT, ATC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:RUDAWSKY
Suffix:
Gender:M
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23924 SUNNY COVE CT
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5695
Mailing Address - Country:US
Mailing Address - Phone:302-381-8348
Mailing Address - Fax:302-947-9822
Practice Address - Street 1:101 GARDEN OF EDEN RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1511
Practice Address - Country:US
Practice Address - Phone:302-477-1536
Practice Address - Fax:302-477-1564
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist