Active NPI
Holly Rudolph
- Physical Therapy Assistant
- Herrin, IL
National Provider Identifier
1932870581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160007391
- Practice address
- 1900 N Park Ave
Herrin, IL 62948-2742 - Phone
- (618) 942-2525
- NPI assigned
- Sep 23, 2021
- Sex
- Female
- 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 Therapy Assistant | 225200000X | 160007391 | IL | Primary |
Addresses
Primary practice location
1900 N Park Ave
Herrin, IL 62948-2742
Mailing address
8210 Tunnel Hill Rd
Goreville, IL 62939-2818
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160007391 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632873600000",
"number": "1932870581",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8210 TUNNEL HILL RD",
"city": "GOREVILLE",
"state": "IL",
"postal_code": "629392818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 N PARK AVE",
"city": "HERRIN",
"state": "IL",
"postal_code": "629482742",
"telephone_number": "618-942-2525"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUDOLPH",
"first_name": "HOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-23",
"last_updated": "2021-09-29",
"certification_date": "2021-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160007391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herrin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.