Provider Demographics
NPI:1437109006
Name:PENCE, JUDITH K (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:K
Last Name:PENCE
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 1:6335 SCORPIO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2233
Mailing Address - Country:US
Mailing Address - Phone:239-272-3674
Mailing Address - Fax:
Practice Address - Street 1:285 8TH ST S
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6123
Practice Address - Country:US
Practice Address - Phone:239-331-4460
Practice Address - Fax:239-331-4437
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist