Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2542 | MN |
NPI | 1003043795 |
---|---|
Provider Name | Paul Rudebusch |
First Address | Willmar, MN 56201-2346 |
Second Address | Ortonville, MN 56278-1138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2009 |
Last Update Date | 19/06/2009 |