Provider Demographics
NPI:1417278268
Name:CUDLIPP, DAVID ((PT))
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CUDLIPP
Suffix:
Gender:M
Credentials:(PT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5771 ENID ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1208
Mailing Address - Country:US
Mailing Address - Phone:713-880-4400
Mailing Address - Fax:713-869-8637
Practice Address - Street 1:805 W NORTH CARRIER PKWY STE 260
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1090
Practice Address - Country:US
Practice Address - Phone:972-623-1111
Practice Address - Fax:972-623-1105
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist