Provider Demographics
NPI:1497098594
Name:JUDSON, NICOLE MARIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:JUDSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5620
Mailing Address - Country:US
Mailing Address - Phone:989-450-3341
Mailing Address - Fax:989-778-1237
Practice Address - Street 1:5460 W ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:MI
Practice Address - Zip Code:48722
Practice Address - Country:US
Practice Address - Phone:989-272-4500
Practice Address - Fax:989-272-4501
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist