Provider Demographics
NPI:1326542572
Name:ANG, JUDY DYCOCO (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:DYCOCO
Last Name:ANG
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 1:3102 INVERNESS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-1919
Mailing Address - Country:US
Mailing Address - Phone:678-899-9794
Mailing Address - Fax:
Practice Address - Street 1:1921 WHITTLESEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3099
Practice Address - Country:US
Practice Address - Phone:706-649-7990
Practice Address - Fax:706-649-7991
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist