Provider Demographics
NPI:1447355870
Name:LEPAGE, JUDY B (PT)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:B
Last Name:LEPAGE
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 1:3001 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5129
Mailing Address - Country:US
Mailing Address - Phone:325-223-6370
Mailing Address - Fax:325-223-6327
Practice Address - Street 1:3001 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5129
Practice Address - Country:US
Practice Address - Phone:325-223-6370
Practice Address - Fax:325-223-6327
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4790225100000X
VA2305202522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist