Provider Demographics
NPI:1780626184
Name:WEATHERBEE, JUDITH A (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WEATHERBEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 225
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:ME
Mailing Address - Zip Code:04489-0225
Mailing Address - Country:US
Mailing Address - Phone:207-433-7778
Mailing Address - Fax:866-220-5031
Practice Address - Street 1:881 POPLAR ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-5918
Practice Address - Country:US
Practice Address - Phone:207-433-7778
Practice Address - Fax:207-433-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT2464OtherPT LICENSE
MEP00295118OtherRAILROAD MEDICARE
ME098049OtherBLUE CROSS & BLUE SHIELD
MEUX9792Medicare PIN
MEMM9134Medicare ID - Type Unspecified