Provider Demographics
NPI:1043662901
Name:NOBACH, JULIE (LMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:NOBACH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 E HOWARD CITY EDMORE RD
Mailing Address - Street 2:
Mailing Address - City:VESTABURG
Mailing Address - State:MI
Mailing Address - Zip Code:48891-9570
Mailing Address - Country:US
Mailing Address - Phone:989-560-1164
Mailing Address - Fax:
Practice Address - Street 1:7400 E HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:VESTABURG
Practice Address - State:MI
Practice Address - Zip Code:48891-9570
Practice Address - Country:US
Practice Address - Phone:989-560-1164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL581971225700000X
MI7501007100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist