Provider Demographics
NPI:1275905069
Name:ZHAO, JUDY AN (DPT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:AN
Last Name:ZHAO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:AN
Other - Last Name:LY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5636 CALIFORNIA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-2334
Mailing Address - Country:US
Mailing Address - Phone:408-786-6552
Mailing Address - Fax:
Practice Address - Street 1:5636 CALIFORNIA ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2334
Practice Address - Country:US
Practice Address - Phone:408-786-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38069OtherCALIFORNIA BOARD OF PHYSICAL THERAPY