Provider Demographics
NPI:1649948886
Name:SEMEYN, JUDD (PT)
Entity type:Individual
Prefix:
First Name:JUDD
Middle Name:
Last Name:SEMEYN
Suffix:
Gender:M
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:PO BOX 3147
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-3147
Mailing Address - Country:US
Mailing Address - Phone:813-253-3092
Mailing Address - Fax:813-259-9516
Practice Address - Street 1:1220 S DALE MABRY HWY STE 101
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5019
Practice Address - Country:US
Practice Address - Phone:813-253-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT3610OtherSTATE OF FLORIDA