Provider Demographics
NPI:1023352895
Name:SHOLES, JUDY LYNN (PTA)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:LYNN
Last Name:SHOLES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14020 NORTH COUNTY LINE ROAD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:IN
Mailing Address - Zip Code:46341
Mailing Address - Country:US
Mailing Address - Phone:219-381-1339
Mailing Address - Fax:
Practice Address - Street 1:14020 NORTH COUNTY LINE ROAD
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:IN
Practice Address - Zip Code:46341
Practice Address - Country:US
Practice Address - Phone:219-381-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002946A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1574Medicare PIN