Provider Demographics
NPI:1336896091
Name:ZEPHIRIN, JUDITH
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ZEPHIRIN
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 1:5009 N SHERIDAN RD APT 905
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1788
Mailing Address - Country:US
Mailing Address - Phone:772-333-1339
Mailing Address - Fax:
Practice Address - Street 1:2960 N LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5600
Practice Address - Country:US
Practice Address - Phone:773-525-3045
Practice Address - Fax:773-482-8329
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160009144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant