Active NPI
Makenzie Jo Judy
- Physical Medicine & Rehabilitation Physician
- Lutz, FL
National Provider Identifier
1043855406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- PT35151
- Practice address
- 2614 Golden Antler LN
Lutz, FL 33559-3130 - Phone
- (417) 658-5308
- NPI assigned
- Nov 8, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | PT35151 | FL | Primary |
Addresses
Primary practice location
2614 Golden Antler LN
Lutz, FL 33559-3130
Mailing address
2614 Golden Antler LN
Lutz, FL 33559-3130
Phone (417) 658-5308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT35151 | FL | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573171200000",
"number": "1043855406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2614 GOLDEN ANTLER LN",
"city": "LUTZ",
"state": "FL",
"postal_code": "335593130",
"telephone_number": "417-658-5308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2614 GOLDEN ANTLER LN",
"city": "LUTZ",
"state": "FL",
"postal_code": "335593130",
"telephone_number": "417-658-5308"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUDY",
"first_name": "MAKENZIE",
"middle_name": "JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-08",
"last_updated": "2019-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "FL",
"license": "PT35151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lutz, FL
- Alexandra Tanley Joseph, D.C.
- Manouche Joseph, CLINICAL SW INTERN
- Joyce Francis (JJ's Group Home& Wraparound)
- Nicholas Robert Joyce, PHD
- Joyful Family Therapy, LLC (Innerglow Therapy)
- Julie J. McKean, LMHC, NCC, LLC
- Courtney J Julien, LM, CPM
- Jungsil K Cusimano MD, Inc.
- Dipali Kadiwar, RPH
- Cassie Hunter Kalbe, DO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.