Provider Demographics
NPI:1912104613
Name:DAVIDSON, JUDITH MORESCO (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:MORESCO
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BANCROFT AVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-4436
Mailing Address - Country:US
Mailing Address - Phone:410-267-0765
Mailing Address - Fax:
Practice Address - Street 1:188 GREEN ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2502
Practice Address - Country:US
Practice Address - Phone:410-222-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0722Medicaid