Provider Demographics
NPI:1770808966
Name:JUDICE, ROBIN J (LMT)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:J
Last Name:JUDICE
Suffix:
Gender:F
Credentials:LMT
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 92064
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-2064
Mailing Address - Country:US
Mailing Address - Phone:337-412-8969
Mailing Address - Fax:337-332-6071
Practice Address - Street 1:213 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-5143
Practice Address - Country:US
Practice Address - Phone:337-332-4686
Practice Address - Fax:337-332-6071
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA4009-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LALA4009-01OtherLISCENSED MASSAGE THERAPIST