Provider Demographics
NPI:1144531559
Name:WATKINS JUDD, KATE MCBRIDE (PT)
Entity type:Individual
Prefix:DR
First Name:KATE
Middle Name:MCBRIDE
Last Name:WATKINS JUDD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:DR
Other - First Name:KATE
Other - Middle Name:M
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20325 N 51ST AVE
Mailing Address - Street 2:BLDG 6, SUITE 148
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5674
Mailing Address - Country:US
Mailing Address - Phone:623-249-3216
Mailing Address - Fax:623-249-3218
Practice Address - Street 1:20325 N 51ST AVE
Practice Address - Street 2:BLDG 6, SUITE 148
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5674
Practice Address - Country:US
Practice Address - Phone:623-249-3216
Practice Address - Fax:623-249-3218
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ89492251X0800X
GAPT0110292251X0800X
AZ07722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer