Provider Demographics
NPI:1851351373
Name:GAZDAG, JUDY (PT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:GAZDAG
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 1:2531 ROCKY RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4446
Mailing Address - Country:US
Mailing Address - Phone:205-744-9889
Mailing Address - Fax:205-744-9225
Practice Address - Street 1:2801 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-1859
Practice Address - Country:US
Practice Address - Phone:205-744-7311
Practice Address - Fax:205-744-7814
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504964OtherBCBS OF ALABAMA
AL051504198Medicare ID - Type Unspecified
AL051504964OtherBCBS OF ALABAMA