Provider Demographics
NPI:1548253404
Name:KUDLA, MICHAEL L (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:KUDLA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:3129 MOUNTAIN HILL DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5005
Mailing Address - Country:US
Mailing Address - Phone:919-257-0361
Mailing Address - Fax:
Practice Address - Street 1:2111 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-2195
Practice Address - Fax:713-731-4862
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0186341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist