Healthcare Provider Details

I. General information

NPI: 1003748450
Provider Name (Legal Business Name): ALEXANDRA CHRISTINE JUDGE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 HIGHWAY 17 N
NORTH MYRTLE BEACH SC
29582-2229
US

IV. Provider business mailing address

192 BRAMBLE CT
BUFFALO NY
14221-1715
US

V. Phone/Fax

Practice location:
  • Phone: 843-353-3460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13438
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7429
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: