Provider Demographics
NPI:1659603793
Name:ANWAR, JUDITH H
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:H
Last Name:ANWAR
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 1:28906 NE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CARNATION
Mailing Address - State:WA
Mailing Address - Zip Code:98014-9689
Mailing Address - Country:US
Mailing Address - Phone:425-417-4617
Mailing Address - Fax:
Practice Address - Street 1:28906 NE 10TH ST
Practice Address - Street 2:
Practice Address - City:CARNATION
Practice Address - State:WA
Practice Address - Zip Code:98014-9689
Practice Address - Country:US
Practice Address - Phone:425-417-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-30
Last Update Date:2010-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022742172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist