Provider Demographics
NPI:1447855689
Name:DR JOSEPH UDOFIA PLLC
Entity type:Organization
Organization Name:DR JOSEPH UDOFIA PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:UDOFIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:903-262-4800
Mailing Address - Street 1:2113 SUANNE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4846
Mailing Address - Country:US
Mailing Address - Phone:903-741-8710
Mailing Address - Fax:903-741-8713
Practice Address - Street 1:2113 SUANNE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4846
Practice Address - Country:US
Practice Address - Phone:903-262-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR JOSEPH UDOFIA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-04
Last Update Date:2023-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy