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General NPI Number Information
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NPI Number | 1235562638
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Entity Type | Individual
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Provider Name | KELSEY DUDGEON DPT
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Gender | Female
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 06/19/2017
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Provider Practice Location Address
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Address Line | 1590 S SR 15A SUITE 2
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City | DELAND
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State | FL
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Zip | 32720-7817
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Country | US
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Telephone | 386-734-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 271 N PENNSYLVANIA AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-3793
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Country | US
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Telephone | 716-341-5920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT 28501
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License Number State | FL
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