Healthcare Provider Details

I. General information

NPI: 1376630012
Provider Name (Legal Business Name): WENDY JO KUDLAWIEC P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 DONALD LN SUITE 10
JOHNSTOWN PA
15904-2835
US

IV. Provider business mailing address

430 INNOVATION DRIVE
BLAIRSVILLE PA
15717-8096
US

V. Phone/Fax

Practice location:
  • Phone: 814-266-1974
  • Fax: 814-266-3407
Mailing address:
  • Phone: 724-343-4060
  • Fax: 724-343-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007529L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: