Healthcare Provider Details

I. General information

NPI: 1497167795
Provider Name (Legal Business Name): JOHN THOMAS DUDZIC LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 WILLAMETTE ST STE 6
EUGENE OR
97401-4075
US

IV. Provider business mailing address

1902 MONTEREY LN
EUGENE OR
97401-1938
US

V. Phone/Fax

Practice location:
  • Phone: 541-357-7810
  • Fax: 458-201-6831
Mailing address:
  • Phone: 315-383-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number20372
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: