Healthcare Provider Details

I. General information

NPI: 1063641892
Provider Name (Legal Business Name): ASHLEY GRACE KUDRON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 N UNION BLVD
COLORADO SPRINGS CO
80918-1744
US

IV. Provider business mailing address

9037 ROLLINS PASS CT
COLORADO SPRINGS CO
80924-7015
US

V. Phone/Fax

Practice location:
  • Phone: 719-434-7044
  • Fax:
Mailing address:
  • Phone: 310-699-0423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: