Provider Demographics
NPI:1235430224
Name:JUDD, PEGGY KATHLEEN (LMT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:KATHLEEN
Last Name:JUDD
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 1:515 FOY AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3831
Mailing Address - Country:US
Mailing Address - Phone:704-431-5762
Mailing Address - Fax:
Practice Address - Street 1:515 FOY AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3831
Practice Address - Country:US
Practice Address - Phone:704-431-5762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9607172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist