Provider Demographics
NPI:1356374763
Name:BLASCZYK, JUDY ANN (RPT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:ANN
Last Name:BLASCZYK
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 1:3323 MISSION DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1827
Mailing Address - Country:US
Mailing Address - Phone:831-465-0107
Mailing Address - Fax:831-465-0109
Practice Address - Street 1:3323 MISSION DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1827
Practice Address - Country:US
Practice Address - Phone:831-465-0107
Practice Address - Fax:831-465-0109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0PT126760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist