Provider Demographics
NPI:1265861587
Name:BARRETT, JUDITH PATRICIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:PATRICIA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:PATRICIA
Other - Last Name:LENTIVECH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1202 HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-3914
Mailing Address - Country:US
Mailing Address - Phone:575-835-1140
Mailing Address - Fax:
Practice Address - Street 1:1202 HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-3914
Practice Address - Country:US
Practice Address - Phone:575-835-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT3824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist