Provider Demographics
NPI:1568237311
Name:STRUDAS, MARK JAMES (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAMES
Last Name:STRUDAS
Suffix:
Gender:M
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 1:7501 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46406-2267
Mailing Address - Country:US
Mailing Address - Phone:219-977-2090
Mailing Address - Fax:
Practice Address - Street 1:7501 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-2267
Practice Address - Country:US
Practice Address - Phone:219-977-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05015390A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic