Provider Demographics
NPI:1689908998
Name:SCHORNAK, JUDY ANN (MT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:SCHORNAK
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2981
Mailing Address - Country:US
Mailing Address - Phone:248-933-6534
Mailing Address - Fax:
Practice Address - Street 1:5885 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2981
Practice Address - Country:US
Practice Address - Phone:248-933-6534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1106317OtherAMERICAN SPECIALTY HEALTH