Provider Demographics
NPI:1083735385
Name:MAXFIELD, JUDY (MT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7249 SECREST CT
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-7622
Mailing Address - Country:US
Mailing Address - Phone:303-263-0802
Mailing Address - Fax:
Practice Address - Street 1:7050 W 120TH AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7604
Practice Address - Country:US
Practice Address - Phone:303-263-0802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COT9106014225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist