Provider Demographics
NPI:1760509616
Name:MOWRY, JUDY (PT)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:MOWRY
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 1:2700 N 3RD ST
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004
Mailing Address - Country:US
Mailing Address - Phone:602-567-2026
Mailing Address - Fax:602-957-4785
Practice Address - Street 1:2700 N 3RD ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-567-2026
Practice Address - Fax:602-957-4785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2029225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ565773Medicaid