Provider Demographics
NPI:1265484406
Name:JUDGE, JAMES D (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:JUDGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19070 EVERETT BLVD
Mailing Address - Street 2:UNIT 206
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-2073
Mailing Address - Country:US
Mailing Address - Phone:708-610-8951
Mailing Address - Fax:
Practice Address - Street 1:2028 W OAKTON ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1958
Practice Address - Country:US
Practice Address - Phone:708-478-1706
Practice Address - Fax:708-478-1766
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-004993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL91024Medicare PIN
IN189890DMedicare PIN