Provider Demographics
NPI:1235553702
Name:HIMEBAUCH, JUDY (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:HIMEBAUCH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 CALYX LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2214
Mailing Address - Country:US
Mailing Address - Phone:419-472-0900
Mailing Address - Fax:419-472-0812
Practice Address - Street 1:930 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-4097
Practice Address - Country:US
Practice Address - Phone:419-472-0900
Practice Address - Fax:419-472-0812
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501008849225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist