Provider Demographics
NPI:1679132047
Name:JUDGE, ROSEANNE LOUISE (PT, DPT, CLT, WCS)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:LOUISE
Last Name:JUDGE
Suffix:
Gender:F
Credentials:PT, DPT, CLT, WCS
Other - Prefix:
Other - First Name:ROSEANNE
Other - Middle Name:
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT, CLT, WCS
Mailing Address - Street 1:517 ADVANCEMENT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6490
Mailing Address - Country:US
Mailing Address - Phone:320-766-4692
Mailing Address - Fax:
Practice Address - Street 1:5920 SANDY FORKS RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3814
Practice Address - Country:US
Practice Address - Phone:919-954-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT018051225100000X
NCP18913225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist