Basic Information
| Provider Information | |||||||||
| NPI: | 1376630012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUDLAWIEC | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 INNOVATION DRIVE | ||||||||
| Address2: | |||||||||
| City: | BLAIRSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157178096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243434060 | ||||||||
| FaxNumber: | 7243434069 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 DONALD LN | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | JOHNSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 159042835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142661974 | ||||||||
| FaxNumber: | 8142663407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT007529L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00125768 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 5354711 | 01 | PA | AETNA | OTHER | 243977 | 01 | PA | HEALTH AMER/HEALTH ASSUR. | OTHER |