Provider Demographics
NPI:1235757741
Name:ALTER, JUDAH BENJAMIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JUDAH
Middle Name:BENJAMIN
Last Name:ALTER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BROOKFALL RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2946
Mailing Address - Country:US
Mailing Address - Phone:732-589-6171
Mailing Address - Fax:
Practice Address - Street 1:30 MONTVUE DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1057
Practice Address - Country:US
Practice Address - Phone:540-743-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty