Provider Demographics
NPI:1912179698
Name:JUDGE, CHARLENE (LMT)
Entity Type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:
Last Name:JUDGE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CENTRAL AVE.
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112
Mailing Address - Country:US
Mailing Address - Phone:386-698-1194
Mailing Address - Fax:
Practice Address - Street 1:10 CENTRAL AVE.
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112
Practice Address - Country:US
Practice Address - Phone:386-698-1194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA13923225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist