Provider Demographics
NPI:1568506905
Name:TEAGUE, JUDITH ELLEN (PT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ELLEN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:21 PEEKSKILL HOLLOW RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3248
Practice Address - Country:US
Practice Address - Phone:845-528-3133
Practice Address - Fax:845-528-0463
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012536-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist