Provider Demographics
NPI:1962435701
Name:JUDD, JOEL DEAN (PT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:DEAN
Last Name:JUDD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8601 GLENBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-1476
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-5849
Practice Address - Country:US
Practice Address - Phone:817-498-3919
Practice Address - Fax:817-498-7080
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113843225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84629TOtherBLUE CROSS BLUE SHIELD
TX84629TOtherBLUE CROSS BLUE SHIELD