Provider Demographics
NPI:1285360990
Name:MUDLO, DYLAN MICHAEL (PT)
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:MICHAEL
Last Name:MUDLO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 BAUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3763
Mailing Address - Country:US
Mailing Address - Phone:412-661-0400
Mailing Address - Fax:
Practice Address - Street 1:5770 BAUM BLVD # 100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3763
Practice Address - Country:US
Practice Address - Phone:412-661-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist