Provider Demographics
NPI:1740516756
Name:JUDD, JAMES ROBERT (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:JUDD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:ROBERT
Other - Last Name:JUDD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:126 LAKE FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1506
Mailing Address - Country:US
Mailing Address - Phone:864-855-5074
Mailing Address - Fax:
Practice Address - Street 1:1306 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3600
Practice Address - Country:US
Practice Address - Phone:864-286-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
SC1147310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility