Provider Demographics
NPI:1285047308
Name:DATOC, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:DATOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 KEY WEST AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3334
Mailing Address - Country:US
Mailing Address - Phone:301-294-0050
Mailing Address - Fax:301-424-9234
Practice Address - Street 1:9420 KEY WEST AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3334
Practice Address - Country:US
Practice Address - Phone:301-294-0050
Practice Address - Fax:301-424-9234
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24988225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist