Provider Demographics
NPI:1881828028
Name:TEMPLE, JUDE N (PTA, ATC)
Entity Type:Individual
Prefix:MR
First Name:JUDE
Middle Name:N
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:PTA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:SLOUGHHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95683-1161
Mailing Address - Country:US
Mailing Address - Phone:707-834-1744
Mailing Address - Fax:
Practice Address - Street 1:6100 STONEHOUSE RD
Practice Address - Street 2:
Practice Address - City:SLOUGHHOUSE
Practice Address - State:CA
Practice Address - Zip Code:95683-9616
Practice Address - Country:US
Practice Address - Phone:707-834-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ08152255A2300X
CA48217225200000X
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer