Provider Demographics
NPI:1033236609
Name:OZERYANSKY, JUDY (PT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:OZERYANSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 BILL CARRUTH PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3754
Mailing Address - Country:US
Mailing Address - Phone:770-443-7136
Mailing Address - Fax:770-443-7153
Practice Address - Street 1:148 BILL CARRUTH PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3754
Practice Address - Country:US
Practice Address - Phone:770-443-7136
Practice Address - Fax:770-443-7153
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
511I650365Medicare PIN