Provider Demographics
NPI:1821200304
Name:THACKABERRY, JUDY H (PT, MPT, GCS)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:H
Last Name:THACKABERRY
Suffix:
Gender:F
Credentials:PT, MPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 RYDER CORNER ROAD
Mailing Address - Street 2:
Mailing Address - City:SUNAPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03782-2815
Mailing Address - Country:US
Mailing Address - Phone:603-763-4504
Mailing Address - Fax:
Practice Address - Street 1:107 NEWPORT ROAD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:603-526-4077
Practice Address - Fax:603-526-4272
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26862251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics