Provider Demographics
NPI:1588968259
Name:RUDDY, NICOLE ANNE (ATC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNE
Last Name:RUDDY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 N POWELL RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-5621
Mailing Address - Country:US
Mailing Address - Phone:303-200-0582
Mailing Address - Fax:
Practice Address - Street 1:5801 S QUEBEC ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2003
Practice Address - Country:US
Practice Address - Phone:303-358-9173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer