Provider Demographics
NPI:1013192780
Name:HERMANN, JUDY A (MSPT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:HERMANN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742
Mailing Address - Street 2:
Mailing Address - City:JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11947-0742
Mailing Address - Country:US
Mailing Address - Phone:631-722-5677
Mailing Address - Fax:
Practice Address - Street 1:6 SIXTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH JAMESPORT
Practice Address - State:NY
Practice Address - Zip Code:11970-0742
Practice Address - Country:US
Practice Address - Phone:631-722-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022273-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL1531Medicare PIN