Provider Demographics
NPI:1952650186
Name:DUDENHOFER, ELIZABETH JOY (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:DUDENHOFER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELIAZABETH
Other - Middle Name:JOY
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9310 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1227
Mailing Address - Country:US
Mailing Address - Phone:509-789-2836
Mailing Address - Fax:509-789-2839
Practice Address - Street 1:9310 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1227
Practice Address - Country:US
Practice Address - Phone:509-789-2836
Practice Address - Fax:509-789-2839
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-7225225100000X
WAPT60290653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952650186Medicaid
WAP01207552OtherRR MEDICARE
WAG8915468Medicare PIN