Healthcare Provider Details

I. General information

NPI: 1396329801
Provider Name (Legal Business Name): NICOLE DUDNEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8326 PINEVILLE MATTHEWS RD STE 404
CHARLOTTE NC
28226-4727
US

IV. Provider business mailing address

612 OAK GLEN DR
DALLAS GA
30132-8000
US

V. Phone/Fax

Practice location:
  • Phone: 704-751-0532
  • Fax: 704-544-1104
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP19404
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: