Healthcare Provider Details

I. General information

NPI: 1134901010
Provider Name (Legal Business Name): JUDE JULIAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CEDAR ST
SAUGERTIES NY
12477-1708
US

IV. Provider business mailing address

8 CEDAR ST
SAUGERTIES NY
12477-1708
US

V. Phone/Fax

Practice location:
  • Phone: 845-394-9275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number013117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: