MEDICARE: MR. COLLIN KUDRNA DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		WI

General Provider Information

NPI Number	:	1225397664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. COLLIN KUDRNA DPT

Provider Business Mailing Address
First Line	:	517 E CLAIREMONT AVE
Second Line	:
City	:	EAU CLAIRE
State	:	WI
Zip	:	54701-6479
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 BOULDER RIDGE RD STE 100
Second Line	:
City	:	BISMARCK
State	:	ND
Zip	:	58503-6199
Country	:	US
Telephone Number	:	701-751-3064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	02/20/2024

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