Provider Demographics
NPI:1801834635
Name:HERSHBERG, JUDITH DALE (PT, DPT, MS)
Entity Type:Individual
Prefix:MISS
First Name:JUDITH
Middle Name:DALE
Last Name:HERSHBERG
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Gender:M
Credentials:PT, DPT, MS
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Mailing Address - Street 1:241 PERKINS ST
Mailing Address - Street 2:B702
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4002
Mailing Address - Country:US
Mailing Address - Phone:617-566-9342
Mailing Address - Fax:617-566-3944
Practice Address - Street 1:653 SUMMER ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-2108
Practice Address - Country:US
Practice Address - Phone:617-269-6262
Practice Address - Fax:617-269-1068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA1619225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA603413OtherHARVARD PILGRIM
MA8211OtherNEIGHBORHOOD HEALTH PLAN
MA0009276OtherAETNA
MA10230200OtherACS
MA467779OtherTUFTS HEALTH PLAN
MAY66014OtherBLUE CROSS
MA6440025OtherUNITED HEALTHCARE
MAY66014OtherBLUE CROSS