Provider Demographics
NPI:1114491842
Name:COLLIER, JULIE RENE (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:RENE
Last Name:COLLIER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HILTY LN
Mailing Address - Street 2:
Mailing Address - City:EAST PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32131-4004
Mailing Address - Country:US
Mailing Address - Phone:386-937-2450
Mailing Address - Fax:
Practice Address - Street 1:203 S MOODY RD
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3903
Practice Address - Country:US
Practice Address - Phone:386-329-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist