Provider Demographics
NPI:1285795831
Name:DUMELOD, JUDIE A (PT, CKTP, IMC, C/NDT)
Entity type:Individual
Prefix:MRS
First Name:JUDIE
Middle Name:A
Last Name:DUMELOD
Suffix:
Gender:F
Credentials:PT, CKTP, IMC, C/NDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ASHVILLE CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1669
Mailing Address - Country:US
Mailing Address - Phone:478-474-4035
Mailing Address - Fax:478-474-7713
Practice Address - Street 1:3351 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2587
Practice Address - Country:US
Practice Address - Phone:478-474-4035
Practice Address - Fax:478-474-7713
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA537484753AMedicaid
GA306817636AMedicaid
GA813105927AMedicaid
GA193449608BMedicaid
GA000760702BMedicaid