Provider Demographics
NPI:1780814715
Name:BIRKMEIER, JUDITH CLARE (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CLARE
Last Name:BIRKMEIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:CLARE
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6016 LOVERS LN
Mailing Address - Street 2:STE 3
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3050
Mailing Address - Country:US
Mailing Address - Phone:269-329-0934
Mailing Address - Fax:269-329-0965
Practice Address - Street 1:6016 LOVERS LN
Practice Address - Street 2:STE 3
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-3050
Practice Address - Country:US
Practice Address - Phone:269-329-0934
Practice Address - Fax:269-329-0965
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist