Provider Demographics
NPI:1982688875
Name:SCHACK, JUDI M (PT)
Entity Type:Individual
Prefix:DR
First Name:JUDI
Middle Name:M
Last Name:SCHACK
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 1:10244 E COLONIAL DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-4374
Mailing Address - Country:US
Mailing Address - Phone:407-282-1003
Mailing Address - Fax:407-282-5560
Practice Address - Street 1:10244 E COLONIAL DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4374
Practice Address - Country:US
Practice Address - Phone:407-282-1003
Practice Address - Fax:407-282-5560
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0004841225100000X, 2251G0304X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY2870OtherBCBS PREFERRED PROVIDER #
FLY2870ZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST