Healthcare Provider Details

I. General information

NPI: 1104132877
Provider Name (Legal Business Name): ROXANNE RENAE KUDWA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 PATIENT CARE DR
LANSING MI
48911-4217
US

IV. Provider business mailing address

3404 PATIENT CARE DR
LANSING MI
48911-4217
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0200
  • Fax: 517-267-1877
Mailing address:
  • Phone: 517-267-0200
  • Fax: 517-267-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: