Provider Demographics
NPI:1114700945
Name:VANOVER, JULIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:VANOVER
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 1:18055 NW 127TH CT
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7816
Mailing Address - Country:US
Mailing Address - Phone:816-223-7679
Mailing Address - Fax:
Practice Address - Street 1:18055 NW 127TH CT
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079-7816
Practice Address - Country:US
Practice Address - Phone:816-223-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist