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General NPI Number Information
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NPI Number | 1245600030
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Entity Type | Individual
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Provider Name | MATTHEW EDWARD DUDEK DPT
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Gender | Male
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 1893 NE MIAMI GARDENS DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33179-5035
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Country | US
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Telephone | 239-699-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 3513 SE 8TH AVE
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City | CAPE CORAL
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State | FL
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Zip | 33904-4902
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Country | US
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Telephone | 239-699-2882
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 29746
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License Number State | FL
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