Healthcare Provider Details

I. General information

NPI: 1770808966
Provider Name (Legal Business Name): ROBIN J JUDICE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 WASHINGTON ST
BREAUX BRIDGE LA
70517-5143
US

IV. Provider business mailing address

PO BOX 92064
LAFAYETTE LA
70509-2064
US

V. Phone/Fax

Practice location:
  • Phone: 337-332-4686
  • Fax: 337-332-6071
Mailing address:
  • Phone: 337-412-8969
  • Fax: 337-332-6071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLA4009-01
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: