Healthcare Provider Details

I. General information

NPI: 1902927726
Provider Name (Legal Business Name): KATHLEEN E KUDUK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 CONSHOHOCKEN AVE
PHILADELPHIA PA
19131-5426
US

IV. Provider business mailing address

219 SUMMERWIND LN
HARLEYSVILLE PA
19438-1863
US

V. Phone/Fax

Practice location:
  • Phone: 215-879-1000
  • Fax: 215-879-3912
Mailing address:
  • Phone: 215-368-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007744L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: