Provider Demographics
NPI:1871520858
Name:DUDA, REBECCA L (BSPT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:L
Last Name:DUDA
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11711 NE 12TH ST
Mailing Address - Street 2:3A
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2461
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:6520 226TH PLACE SE
Practice Address - Street 2:201
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8969
Practice Address - Country:US
Practice Address - Phone:425-391-5504
Practice Address - Fax:425-391-3670
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPT00003663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA39830OtherL & I
WA7021736Medicaid
WA7021736Medicaid