Provider Demographics
NPI:1083884258
Name:WALLACE, JULIE B (CMT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:WALLACE
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E KENTUCKY AVE STE 446
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2078
Mailing Address - Country:US
Mailing Address - Phone:303-759-1400
Mailing Address - Fax:888-308-3357
Practice Address - Street 1:4340 E KENTUCKY AVE STE 446
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-2078
Practice Address - Country:US
Practice Address - Phone:303-759-1400
Practice Address - Fax:888-308-3357
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist