Provider Demographics
NPI:1003006909
Name:PINKHAM, JULIA ANN (LMT, LAC)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:ANN
Last Name:PINKHAM
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2170 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-4076
Mailing Address - Country:US
Mailing Address - Phone:614-486-7525
Mailing Address - Fax:614-488-4736
Practice Address - Street 1:2170 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-486-7525
Practice Address - Fax:614-488-4736
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13564225700000X
OH118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist