Provider Demographics
NPI:1174685168
Name:HORAK, JULIE B (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:HORAK
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 1:113 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2360
Mailing Address - Country:US
Mailing Address - Phone:989-725-6101
Mailing Address - Fax:989-723-3601
Practice Address - Street 1:113 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2360
Practice Address - Country:US
Practice Address - Phone:989-725-6101
Practice Address - Fax:989-723-3601
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M09140008Medicare PIN