Healthcare Provider Details

I. General information

NPI: 1548253404
Provider Name (Legal Business Name): MICHAEL L KUDLA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 SAWYER DR
NIAGARA FALLS NY
14304-2975
US

IV. Provider business mailing address

3129 MOUNTAIN HILL DR
WAKE FOREST NC
27587-5005
US

V. Phone/Fax

Practice location:
  • Phone: 716-731-2195
  • Fax: 713-731-4862
Mailing address:
  • Phone: 919-257-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0186341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: