Provider Demographics
NPI:1962401323
Name:DUDZIC, JASON P (PT)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:P
Last Name:DUDZIC
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 1:1910 SASSAFRAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-452-5231
Mailing Address - Fax:814-452-7855
Practice Address - Street 1:1910 SASSAFRAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2716
Practice Address - Country:US
Practice Address - Phone:814-452-5231
Practice Address - Fax:814-452-7855
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P82481Medicare UPIN
OH2448677OtherOH MEDICAL ASSISTANCE
PA146210OtherUNISON
PA3110688OtherAETNA
P82481Medicare UPIN
PA0018514560003Medicaid
PA1300889OtherBLUE SHIELD
PA067694E7CMedicare PIN