Provider Demographics
NPI:1326194655
Name:DUDLEY, CHARLES CHRISTOPHER (PT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:CHRISTOPHER
Last Name:DUDLEY
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 1:1426 GOODWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6014
Mailing Address - Country:US
Mailing Address - Phone:443-854-9085
Mailing Address - Fax:410-630-7061
Practice Address - Street 1:1426 GOODWOOD AVE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:443-854-9085
Practice Address - Fax:410-630-7061
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19892225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist