Provider Demographics
NPI:1912093410
Name:BLANK, JUDITH K (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:K
Last Name:BLANK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:3240 HENRY HUDSON PKWY
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-601-8586
Mailing Address - Fax:718-601-8293
Practice Address - Street 1:3240 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 3E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-601-8586
Practice Address - Fax:718-601-8293
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY001577-1225100000X, 2251H1300X
2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ50491Medicare ID - Type UnspecifiedPHYSICAL THERAPIST