Provider Demographics
NPI:1215218409
Name:MIX, JULIANNA (PTA)
Entity Type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:MIX
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 1:5712 W SUMAC AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-0686
Mailing Address - Country:US
Mailing Address - Phone:303-734-8564
Mailing Address - Fax:
Practice Address - Street 1:2525 S WADSWORTH BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3273
Practice Address - Country:US
Practice Address - Phone:720-962-4555
Practice Address - Fax:720-962-4466
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant