Provider Demographics
NPI:1164757241
Name:RAFFARD, JUDITH ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:ANN
Last Name:RAFFARD
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 1:4929 E LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HONEOYE
Mailing Address - State:NY
Mailing Address - Zip Code:14471-9674
Mailing Address - Country:US
Mailing Address - Phone:585-797-8384
Mailing Address - Fax:
Practice Address - Street 1:4893 E LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:HONEOYE
Practice Address - State:NY
Practice Address - Zip Code:14471-9677
Practice Address - Country:US
Practice Address - Phone:585-797-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0164521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist