Provider Demographics
NPI:1033678198
Name:JUDD, BRENDA JEAN (LMT, LE)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JEAN
Last Name:JUDD
Suffix:
Gender:F
Credentials:LMT, LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 W 2100 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8586
Mailing Address - Country:US
Mailing Address - Phone:435-760-9056
Mailing Address - Fax:
Practice Address - Street 1:513 W 2100 N
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8586
Practice Address - Country:US
Practice Address - Phone:435-760-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10442838-4701225700000X
UT10442838-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist