Provider Demographics
NPI:1659496503
Name:DUDLEY, AARON LELAND (MPT)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:LELAND
Last Name:DUDLEY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CREEKMERE DR
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-9755
Mailing Address - Country:US
Mailing Address - Phone:214-931-9931
Mailing Address - Fax:
Practice Address - Street 1:2800 STATE HIGHWAY 114
Practice Address - Street 2:SUITE 220
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-491-3403
Practice Address - Fax:817-491-3308
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist