Provider Demographics
NPI:1154459832
Name:GROUT, JULIE CATHERINE (MPT,ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:CATHERINE
Last Name:GROUT
Suffix:
Gender:F
Credentials:MPT,ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ZEAGLER DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3888
Mailing Address - Country:US
Mailing Address - Phone:904-755-8844
Mailing Address - Fax:
Practice Address - Street 1:205 ZEAGLER DR
Practice Address - Street 2:SUITE 401
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3888
Practice Address - Country:US
Practice Address - Phone:904-755-8844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y904KOtherBCBS PROVIDER #
FLK1374OtherMEDICARE GROUP PROVIDER