Healthcare Provider Details

I. General information

NPI: 1528692720
Provider Name (Legal Business Name): AMBER JUDICKAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER PAVLOSKI

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 JOURNEY WAY
VALPARAISO IN
46383-0078
US

IV. Provider business mailing address

2045 E 84TH ST APT 1B
MERRILLVILLE IN
46410-5087
US

V. Phone/Fax

Practice location:
  • Phone: 219-255-4378
  • Fax:
Mailing address:
  • Phone: 630-430-0023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06006090A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: