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Individual

TIM J KUDLOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
215 E JACKSON BLVD, SUITE B, SPEARFISH, SD 57783-2176
(605) 722-6880
(605) 722-6889
Mailing address
215 E JACKSON BLVD, SUITE B, SPEARFISH, SD 57783-2176
(605) 722-6880
(605) 722-6889

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0542
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0041172
BLUE CROSS BLUE SHIELD SD
SD
05
5831434
SD
Enumeration date
01/31/2007
Last updated
07/09/2007
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