Provider Demographics
NPI:1215227418
Name:GAY, JUDY CAROL (PTA)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:CAROL
Last Name:GAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S LOOP 499
Mailing Address - Street 2:# J 6
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2515
Mailing Address - Country:US
Mailing Address - Phone:956-541-2102
Mailing Address - Fax:956-541-2502
Practice Address - Street 1:902 S LOOP 499
Practice Address - Street 2:# J 6
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2515
Practice Address - Country:US
Practice Address - Phone:309-453-3439
Practice Address - Fax:956-541-2502
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2011-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004838225200000X
TX2070398225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant