Provider Demographics
NPI:1033117320
Name:DUDA, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DUDA
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 1:5350 MANHATTAN CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4272
Mailing Address - Country:US
Mailing Address - Phone:303-543-1201
Mailing Address - Fax:303-543-1206
Practice Address - Street 1:5350 MANHATTAN CIR STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4272
Practice Address - Country:US
Practice Address - Phone:303-543-1201
Practice Address - Fax:303-543-1206
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7742OtherPHYSICAL THERAPY LICENSE
CO7742OtherPHYSICAL THERAPY LICENSE