Provider Demographics
NPI:1609088681
Name:ABRAHAM, JUDITH FRAYDA (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:FRAYDA
Last Name:ABRAHAM
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 1:19 POND RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019-2624
Mailing Address - Country:US
Mailing Address - Phone:860-693-0606
Mailing Address - Fax:860-693-2475
Practice Address - Street 1:19 POND RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-2624
Practice Address - Country:US
Practice Address - Phone:860-693-0606
Practice Address - Fax:860-693-2475
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist