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General NPI Number Information
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NPI Number | 1497098594
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Entity Type | Individual
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Provider Name | NICOLE MARIE JUDSON PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 03/27/2013
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 5460 W ROLLING HILLS DR
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City | BRIDGEPORT
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State | MI
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Zip | 48722
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Country | US
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Telephone | 989-272-4500
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Fax | 989-272-4501
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Provider Business Mailing Address
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Address Line | 804 N WATER ST
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City | BAY CITY
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State | MI
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Zip | 48708-5620
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Country | US
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Telephone | 989-450-3341
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Fax | 989-778-1237
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501016192
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License Number State | MI
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