Provider Demographics
NPI:1861764870
Name:BOLGER, JUDITH L (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:BOLGER
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 1:23 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03223-4259
Mailing Address - Country:US
Mailing Address - Phone:603-254-6939
Mailing Address - Fax:
Practice Address - Street 1:790 LAKE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:NH
Practice Address - Zip Code:03222-4548
Practice Address - Country:US
Practice Address - Phone:603-744-0275
Practice Address - Fax:603-744-9378
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist