Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1229 | AZ |
NPI | 1003157728 |
---|---|
Provider Name | Mrs. Judith Savage Shoup |
First Address | Phoenix, AZ 85051-1305 |
Second Address | Phoenix, AZ 85051-1305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2013 |
Last Update Date | 05/03/2013 |