MEDICARE: JAMES D JUDGE P.T.

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
1	225100000X	Physical Therapist	070-004993	IL

General Provider Information

NPI Number	:	1265484406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES D JUDGE P.T.

Provider Business Mailing Address
First Line	:	19070 EVERETT BLVD
Second Line	:	UNIT 206
City	:	MOKENA
State	:	IL
Zip	:	60448-2073
Country	:	US
Telephone Number	:	708-610-8951
Fax Number	:

Provider Business Practice Location Address
First Line	:	2028 W OAKTON ST
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-1958
Country	:	US
Telephone Number	:	708-478-1706
Fax Number	:	708-478-1766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/29/2019

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