Healthcare Provider Details

I. General information

NPI: 1881821304
Provider Name (Legal Business Name): VIRGINIA MAY KUDRITZKI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 NW 62ND ST
SEATTLE WA
98107-2513
US

IV. Provider business mailing address

2811 NW 62ND ST
SEATTLE WA
98107-2513
US

V. Phone/Fax

Practice location:
  • Phone: 406-529-4598
  • Fax:
Mailing address:
  • Phone: 406-529-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: