Provider Demographics
NPI:1548789696
Name:WADE, AJA DUDLEY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:DUDLEY
Last Name:WADE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 SW 86TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8528
Mailing Address - Country:US
Mailing Address - Phone:813-390-8565
Mailing Address - Fax:
Practice Address - Street 1:1203 NW 16TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4023
Practice Address - Country:US
Practice Address - Phone:352-373-7337
Practice Address - Fax:352-377-3611
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist