MEDICARE: REBECCA L DUDA BSPT

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	PT00003663	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39830	OTHER	WA	L & I
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871520858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L DUDA BSPT

Provider Business Mailing Address
First Line	:	11711 NE 12TH ST
Second Line	:	3A
City	:	BELLEVUE
State	:	WA
Zip	:	98005-2461
Country	:	US
Telephone Number	:	425-450-9474
Fax Number	:	425-452-0704

Provider Business Practice Location Address
First Line	:	6520 226TH PLACE SE
Second Line	:	201
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-8969
Country	:	US
Telephone Number	:	425-391-5504
Fax Number	:	425-391-3670

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	08/17/2010

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Directions to “ REBECCA L DUDA BSPT” Practice Location

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