Provider Demographics
NPI:1801852801
Name:ROSSI, JUDITH STARR (PT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:STARR
Last Name:ROSSI
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 1:142 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5005
Mailing Address - Country:US
Mailing Address - Phone:770-851-3614
Mailing Address - Fax:
Practice Address - Street 1:147 REINHARDT COLLEGE PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5641
Practice Address - Country:US
Practice Address - Phone:770-345-3057
Practice Address - Fax:770-345-3154
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52242462OtherBLUE CROSS BLUE SHIELD
GA52242462OtherBLUE CROSS BLUE SHIELD
GA52242462OtherBLUE CROSS BLUE SHIELD