Provider Demographics
NPI:1760958615
Name:KUDLA, TIMOTHY LOUIS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LOUIS
Last Name:KUDLA
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 1:288 W BITTERS RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1665
Mailing Address - Country:US
Mailing Address - Phone:210-297-9906
Mailing Address - Fax:
Practice Address - Street 1:288 W BITTERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-1665
Practice Address - Country:US
Practice Address - Phone:210-297-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic