Healthcare Provider Details

I. General information

NPI: 1407401532
Provider Name (Legal Business Name): PATRICK JOSEPH DUDLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 FOULK RD
WILMINGTON DE
19803-3158
US

IV. Provider business mailing address

3848 FAU BLVD STE 105
BOCA RATON FL
33431-6437
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-1536
  • Fax:
Mailing address:
  • Phone: 561-395-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0004117
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: