Provider Demographics
NPI:1659403103
Name:STEPHENSON, JUDITH PAIGE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:PAIGE
Last Name:STEPHENSON
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 1:822 44TH ST E
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1532
Mailing Address - Country:US
Mailing Address - Phone:229-402-1227
Mailing Address - Fax:
Practice Address - Street 1:822 44TH ST E
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1532
Practice Address - Country:US
Practice Address - Phone:229-402-1227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT003396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist