Provider Demographics
NPI:1114625126
Name:DARUL CHUDZINSKA, JOLANTA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JOLANTA
Middle Name:
Last Name:DARUL CHUDZINSKA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 WATER WHEEL RUN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9156
Mailing Address - Country:US
Mailing Address - Phone:260-403-7877
Mailing Address - Fax:
Practice Address - Street 1:1900 RANDALLIA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4632
Practice Address - Country:US
Practice Address - Phone:260-484-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005510A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist