Provider Demographics
NPI:1952650186
Name:DUDENHOFER, ELIZABETH JOY (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:DUDENHOFER
Suffix:
Gender:
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:51 COWLITZ ST W
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611-9267
Practice Address - Country:US
Practice Address - Phone:360-274-4550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCP042859T225100000X
SCCP042860T225100000X
IDPT-7225225100000X
ORCP043195T225100000X
UTCP042861T225100000X
DECP043196T225100000X
WAPT60290653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1952650186Medicaid
WAP01207552OtherRR MEDICARE
WAG8915468Medicare PIN