Provider Demographics
NPI:1134545007
Name:KARRENBROCK, JUDY (LPT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:KARRENBROCK
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15948 HAYES RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-2074
Mailing Address - Country:US
Mailing Address - Phone:903-574-3750
Mailing Address - Fax:817-697-0007
Practice Address - Street 1:308 N OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-6613
Practice Address - Country:US
Practice Address - Phone:903-574-3750
Practice Address - Fax:817-697-0007
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1048478225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160575004Medicaid