Provider Demographics
NPI:1588377436
Name:RUDY, MATTHEW D (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:RUDY
Suffix:
Gender:M
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 1:318 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3614
Mailing Address - Country:US
Mailing Address - Phone:610-566-1400
Mailing Address - Fax:610-566-1179
Practice Address - Street 1:318 S ORANGE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3698
Practice Address - Country:US
Practice Address - Phone:610-566-1400
Practice Address - Fax:610-566-1179
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist