Provider Demographics
NPI:1528890001
Name:DUDIN, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DUDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S POTOMAC ST STE 114
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4529
Mailing Address - Country:US
Mailing Address - Phone:303-745-6717
Mailing Address - Fax:
Practice Address - Street 1:1390 S POTOMAC ST STE 114
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4529
Practice Address - Country:US
Practice Address - Phone:303-745-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0019091225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist