Healthcare Provider Details

I. General information

NPI: 1407761109
Provider Name (Legal Business Name): JESSICA UDINK PT, DPT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 NW 2ND ST APT 614
MIAMI FL
33126-5405
US

IV. Provider business mailing address

4242 NW 2ND ST APT 614
MIAMI FL
33126-5405
US

V. Phone/Fax

Practice location:
  • Phone: 310-936-4732
  • Fax:
Mailing address:
  • Phone:
  • 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: