Provider Demographics
NPI:1518929827
Name:JUDD, DENNIS M (PT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:M
Last Name:JUDD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 AIRLINE DRIVE
Mailing Address - Street 2:SUITE 123
Mailing Address - City:COLONIE
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-456-6653
Mailing Address - Fax:518-456-7472
Practice Address - Street 1:4 AIRLINE DRIVE
Practice Address - Street 2:SUITE 123
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-456-6653
Practice Address - Fax:518-456-7472
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02250860Medicaid
NY02250860Medicaid
56563AMedicare ID - Type Unspecified