Provider Demographics
NPI:1932152311
Name:DUDEK, MOLLY BURKE (PTA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:BURKE
Last Name:DUDEK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 N LYDELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4525
Mailing Address - Country:US
Mailing Address - Phone:414-332-7110
Mailing Address - Fax:
Practice Address - Street 1:2025 E. NEWPORT AVE.
Practice Address - Street 2:COLUMBIA-ST. MARY'S HOSPITAL
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211
Practice Address - Country:US
Practice Address - Phone:414-961-4160
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1066-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant