Provider Demographics
NPI:1801077433
Name:MYNDERUP, JUDD WAYNE (MPT)
Entity type:Individual
Prefix:MR
First Name:JUDD
Middle Name:WAYNE
Last Name:MYNDERUP
Suffix:
Gender:M
Credentials:MPT
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 602
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0602
Mailing Address - Country:US
Mailing Address - Phone:559-582-9323
Mailing Address - Fax:559-582-0249
Practice Address - Street 1:311 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3951
Practice Address - Country:US
Practice Address - Phone:559-582-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-26
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist