Provider Demographics
NPI:1255983698
Name:DUMADAG, LOUDES GOZON (PT)
Entity type:Individual
Prefix:MRS
First Name:LOUDES
Middle Name:GOZON
Last Name:DUMADAG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JOSLEN HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1027
Mailing Address - Country:US
Mailing Address - Phone:260-416-6554
Mailing Address - Fax:
Practice Address - Street 1:1 WHITTIER WAY
Practice Address - Street 2:
Practice Address - City:GHENT
Practice Address - State:NY
Practice Address - Zip Code:12075-3213
Practice Address - Country:US
Practice Address - Phone:518-828-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042733-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist