Provider Demographics
NPI:1669244190
Name:JUDSON, RENY CECIL (PT)
Entity type:Individual
Prefix:MR
First Name:RENY
Middle Name:CECIL
Last Name:JUDSON
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 1:1706 TEXAS HILLS CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5849
Mailing Address - Country:US
Mailing Address - Phone:347-772-4472
Mailing Address - Fax:
Practice Address - Street 1:1705 W UNIVERSITY DR STE 119
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3219
Practice Address - Country:US
Practice Address - Phone:972-569-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1379712225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty