Provider Demographics
NPI:1790852234
Name:JUDGE, DAWN M (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:JUDGE
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 1:18282 MUNN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44023-6162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:35000 KAISER CT
Practice Address - Street 2:SUITE 301
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3382
Practice Address - Country:US
Practice Address - Phone:440-951-6677
Practice Address - Fax:440-951-2820
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-5921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJU4213361Medicare PIN
OHJU4213362Medicare PIN