Provider Demographics
NPI:1588796627
Name:MCROBB, JUDY LYNN (NCTMB CERTIFIED)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LYNN
Last Name:MCROBB
Suffix:
Gender:F
Credentials:NCTMB CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1645
Mailing Address - Country:US
Mailing Address - Phone:248-549-3711
Mailing Address - Fax:248-549-3011
Practice Address - Street 1:3314 NORMANDY RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-1645
Practice Address - Country:US
Practice Address - Phone:248-549-3711
Practice Address - Fax:248-549-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI017832-00OtherNAT'L CERT. MASSAGE THER.