Provider Demographics
NPI:1790820124
Name:JUDD, DEBBIE (PT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:JUDD
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:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03247-0509
Mailing Address - Country:US
Mailing Address - Phone:603-524-8811
Mailing Address - Fax:603-524-0288
Practice Address - Street 1:67 COMMUNICATION DR
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-1440
Practice Address - Country:US
Practice Address - Phone:603-524-8811
Practice Address - Fax:603-524-0288
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0805719Y0NH01Medicare UPIN
NH6101906Medicare UPIN