Active NPI
Chadd Lee Rudisill, MPT
- Physical Therapist
- Hanover, PA
National Provider Identifier
1790737476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT015215
- Practice address
- 207 Blooming Grove Rd
Sport Center PT
Hanover, PA 17331-7917 - Phone
- (717) 632-3431
- Fax
- (717) 633-5143
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT015215 | PA | Primary |
Addresses
Primary practice location
207 Blooming Grove Rd
Sport Center PT
Hanover, PA 17331-7917
Mailing address
207 Blooming Grove Rd
Hanover, PA 17331-7917
Phone (717) 632-3431
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT015215 | Other | PA | PA LICENSE # |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT015215 | PA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256083200000",
"number": "1790737476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 BLOOMING GROVE RD",
"city": "HANOVER",
"state": "PA",
"postal_code": "173317917",
"telephone_number": "717-632-3431",
"fax_number": "717-633-5143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "207 BLOOMING GROVE RD",
"address_2": "SPORT CENTER PT",
"city": "HANOVER",
"state": "PA",
"postal_code": "173317917",
"telephone_number": "717-632-3431",
"fax_number": "717-633-5143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDISILL",
"first_name": "CHADD",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2009-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "PA",
"license": "PT015215",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE #",
"identifier": "PT015215",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hanover, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.