Provider Demographics
NPI:1114126273
Name:DOUGLAS, JULIA MAE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:JULIA
Middle Name:MAE
Last Name:DOUGLAS
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 1:3014 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1921
Mailing Address - Country:US
Mailing Address - Phone:810-725-2235
Mailing Address - Fax:
Practice Address - Street 1:3014 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1921
Practice Address - Country:US
Practice Address - Phone:810-725-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant