Provider Demographics
NPI:1316293335
Name:RUDAVSKY, ALIZA CHANA (PT)
Entity type:Individual
Prefix:
First Name:ALIZA
Middle Name:CHANA
Last Name:RUDAVSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 REC HALL
Mailing Address - Street 2:PENN STATE UNIVERSITY
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802
Mailing Address - Country:US
Mailing Address - Phone:412-721-2121
Mailing Address - Fax:
Practice Address - Street 1:267 REC HALL
Practice Address - Street 2:PENN STATE UNIVERSITY
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802
Practice Address - Country:US
Practice Address - Phone:412-721-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09221R225100000X
PADAPT004241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist