MEDICARE: KELLY DUDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7742	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7742	OTHER	CO	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1033117320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY DUDA

Provider Business Mailing Address
First Line	:	5350 MANHATTAN CIR STE 100
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-4272
Country	:	US
Telephone Number	:	303-543-1201
Fax Number	:	303-543-1206

Provider Business Practice Location Address
First Line	:	5350 MANHATTAN CIR STE 100
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80303-4272
Country	:	US
Telephone Number	:	303-543-1201
Fax Number	:	303-543-1206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	09/08/2023

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Directions to “ KELLY DUDA ” Practice Location

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