Provider Demographics
NPI:1912210360
Name:SLY, JUDITH (RPT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SLY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 JORDAN HILLS CT
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-2368
Mailing Address - Country:US
Mailing Address - Phone:727-461-3896
Mailing Address - Fax:727-443-4085
Practice Address - Street 1:1478 JORDAN HILLS CT
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-2368
Practice Address - Country:US
Practice Address - Phone:727-461-3896
Practice Address - Fax:727-443-4085
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist