Provider Demographics
NPI:1447473087
Name:JUODAITIS, VIDA MARIA
Entity type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:MARIA
Last Name:JUODAITIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 EASTER BROOK RD
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1677
Mailing Address - Country:US
Mailing Address - Phone:978-582-4982
Mailing Address - Fax:978-582-5592
Practice Address - Street 1:56 BOYDEN RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-2570
Practice Address - Country:US
Practice Address - Phone:508-829-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA87952251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics