Provider Demographics
NPI:1851539142
Name:HORROCKS, JUDITH A (PT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:HORROCKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:A
Other - Last Name:QUAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:25 RIVIERA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5694
Mailing Address - Country:US
Mailing Address - Phone:928-505-5555
Mailing Address - Fax:928-505-2877
Practice Address - Street 1:1791 MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5648
Practice Address - Country:US
Practice Address - Phone:928-855-4248
Practice Address - Fax:928-855-7452
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ412375Medicaid
Z127670Medicare PIN