Provider Demographics
NPI:1114378593
Name:MEDUNA, JUDITH LYNN (LMT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LYNN
Last Name:MEDUNA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 ASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-2535
Mailing Address - Country:US
Mailing Address - Phone:303-775-8786
Mailing Address - Fax:
Practice Address - Street 1:630 COFFMAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8302
Practice Address - Country:US
Practice Address - Phone:303-652-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist