Provider Demographics
NPI:1306303748
Name:JUDD, VICTOR REED (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:REED
Last Name:JUDD
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
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 984
Mailing Address - Street 2:
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017-0984
Mailing Address - Country:US
Mailing Address - Phone:435-513-1431
Mailing Address - Fax:
Practice Address - Street 1:2186 ECHO DAM RD
Practice Address - Street 2:
Practice Address - City:COALVILLE
Practice Address - State:UT
Practice Address - Zip Code:84017-9007
Practice Address - Country:US
Practice Address - Phone:435-513-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105281-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist