Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 10871 | CO |
NPI | 1023322773 |
---|---|
Provider Name | Mr. Justin T Dudley |
First Address | Denver, CO 80206-7000 |
Second Address | Broomfield, CO 80020-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 04/08/2010 |