Provider Demographics
NPI:1548526502
Name:MARSHALL, JUDY ANN
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JDUITH
Other - Middle Name:ANN
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9 COUNTY VIEW RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 FORTS FERRY RD.
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-785-9203
Practice Address - Fax:518-783-8874
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics