Provider Demographics
NPI:1619559945
Name:MAXEY, JUDITH PACK
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:PACK
Last Name:MAXEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HATCHER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-1256
Mailing Address - Country:US
Mailing Address - Phone:540-483-9261
Mailing Address - Fax:540-483-0589
Practice Address - Street 1:300 HATCHER ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-1256
Practice Address - Country:US
Practice Address - Phone:540-483-9261
Practice Address - Fax:540-483-0589
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant