MEDICARE: DR. JUDI M SCHACK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0004841	FL
2	2251G0304X	Geriatric Physical Therapist	PT0004841	FL
3	2251S0007X	Sports Physical Therapist	PT0004841	FL
4	2251X0800X	Orthopedic Physical Therapist	PT0004841	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y2870	OTHER	FL	BCBS PREFERRED PROVIDER #

General Provider Information

NPI Number	:	1982688875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDI M SCHACK PT

Provider Business Mailing Address
First Line	:	10244 E COLONIAL DR
Second Line	:	SUITE 202
City	:	ORLANDO
State	:	FL
Zip	:	32817-4374
Country	:	US
Telephone Number	:	407-282-1003
Fax Number	:	407-282-5560

Provider Business Practice Location Address
First Line	:	10244 E COLONIAL DR
Second Line	:	SUITE 202
City	:	ORLANDO
State	:	FL
Zip	:	32817-4374
Country	:	US
Telephone Number	:	407-282-1003
Fax Number	:	407-282-5560

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2005
Last Update Date	:	09/11/2025

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Directions to “ DR. JUDI M SCHACK PT” Practice Location

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