Individual provider Active NPI

Wendy Jo Kudlawiec, P.T.

  • Physical Therapist
  • Johnstown, PA
National Provider Identifier
1376630012
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT007529L Issued in PA
Practice address
184 Donald LN
Suite 10
Johnstown, PA 15904-2835
Phone
(814) 266-1974
Fax
(814) 266-3407
NPI assigned
Oct 6, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT007529L PA Primary

Addresses

Primary practice location

184 Donald LN
Suite 10
Johnstown, PA 15904-2835

Mailing address

430 Innovation Drive
Blairsville, PA 15717-8096
Phone (724) 343-4060

Other identifiers 3

IdentifierTypeStateIssuer
00125768OtherPAHIGHMARK BLUE SHIELD
5354711OtherPAAETNA
243977OtherPAHEALTH AMER/HEALTH ASSUR.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200925000388 PA Practitioner - Physical Therapist in Private Practice 2466871439 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pinnacle Rehabilitation Systems, Inc Physical Therapist CurrentSince Aug 31, 2020 Accepting new patients
Benchmark Therapy, Inc Physical Therapist Past Accepting new patients
Benchmark Therapy, Inc Past Accepting new patients
Benchmark Therapy, Inc. Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1376630012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 INNOVATION DRIVE",
            "city": "BLAIRSVILLE",
            "state": "PA",
            "postal_code": "157178096",
            "telephone_number": "724-343-4060",
            "fax_number": "724-343-4069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 DONALD LN",
            "address_2": "SUITE 10",
            "city": "JOHNSTOWN",
            "state": "PA",
            "postal_code": "159042835",
            "telephone_number": "814-266-1974",
            "fax_number": "814-266-3407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLAWIEC",
        "first_name": "WENDY",
        "middle_name": "JO",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT007529L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "00125768",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5354711",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH AMER/HEALTH ASSUR.",
            "identifier": "243977",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnstown, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.