Provider Demographics
NPI:1740398726
Name:SILLS, JUDY KAY (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:KAY
Last Name:SILLS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:KAY
Other - Last Name:HONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:15708 NE 219TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRUSH PRAIRIE
Mailing Address - State:WA
Mailing Address - Zip Code:98606-5408
Mailing Address - Country:US
Mailing Address - Phone:360-891-7046
Mailing Address - Fax:
Practice Address - Street 1:12607 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6055
Practice Address - Country:US
Practice Address - Phone:360-896-4451
Practice Address - Fax:360-891-6297
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007413225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist