Provider Demographics
NPI:1407991102
Name:ROWE, JUDY BURCHFIELD (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:BURCHFIELD
Last Name:ROWE
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 1:11443 ASHTON LN E
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4429
Mailing Address - Country:US
Mailing Address - Phone:228-861-0951
Mailing Address - Fax:228-896-2825
Practice Address - Street 1:11443 ASHTON LN E
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4429
Practice Address - Country:US
Practice Address - Phone:228-861-0591
Practice Address - Fax:228-896-2825
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMSPT0399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07221312Medicaid