Healthcare Provider Details

I. General information

NPI: 1982688875
Provider Name (Legal Business Name): JUDI M SCHACK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10244 E COLONIAL DR SUITE 202
ORLANDO FL
32817-4374
US

IV. Provider business mailing address

10244 E COLONIAL DR SUITE 202
ORLANDO FL
32817-4374
US

V. Phone/Fax

Practice location:
  • Phone: 407-282-1003
  • Fax: 407-282-5560
Mailing address:
  • Phone: 407-282-1003
  • Fax: 407-282-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT0004841
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT0004841
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT0004841
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT0004841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: