MEDICARE: JILL DUDDLESTON 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	PTH10155	AL
2	225100000X	Physical Therapist	157257	AK
3	225100000X	Physical Therapist	047425	NY
4	2251P0200X	Pediatric Physical Therapist	047425-01	NY

General Provider Information

NPI Number	:	1265057285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL DUDDLESTON DPT

Provider Business Mailing Address
First Line	:	517 FALLBROOK DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-4927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 N GENERAL BRUCE DR
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76504-2468
Country	:	US
Telephone Number	:	254-780-9658
Fax Number	:

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

Provider Enumeration Date	:	06/15/2020
Last Update Date	:	08/17/2025

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