Provider Demographics
NPI:1164481149
Name:HOLMES, JUDITH LYNNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LYNNE
Last Name:HOLMES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:LYNNE
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3345 QUAKER VILLAGE
Mailing Address - Street 2:
Mailing Address - City:WEYBRIDGE
Mailing Address - State:VT
Mailing Address - Zip Code:05753-8760
Mailing Address - Country:US
Mailing Address - Phone:802-545-2855
Mailing Address - Fax:
Practice Address - Street 1:295 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-8518
Practice Address - Country:US
Practice Address - Phone:802-398-2700
Practice Address - Fax:802-398-2702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003288225100000X
CAPT11048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT376918OtherMVP
VT49357OtherBCBS
VTVN3188Medicare ID - Type Unspecified