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NPI Code Detail

MEDICARE: MRS. JUDY B STCLAIR PTA

MEDICARE: MRS. JUDY B STCLAIR PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant06002764AIN
2225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1083932958
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JUDY B STCLAIR PTA
Provider Business Mailing Address
First Line : 130 JACKSON BLVD
Second Line :
City : TERRE HAUTE
State : IN
Zip : 47803-1910
Country : US
Telephone Number : 812-870-7475
Fax Number :
Provider Business Practice Location Address
First Line : 3461 SAINT MARYS RD
Second Line :
City : WEST TERRE HAUTE
State : IN
Zip : 47885-9683
Country : US
Telephone Number : 812-917-5618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2010
Last Update Date : 06/02/2021

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Directions to “ MRS. JUDY B STCLAIR PTA” Practice Location

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