Provider Demographics
NPI:1225429616
Name:LIVELY, JULIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:LIVELY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:GOLDEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 306393
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6393
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:1241 PT MALLARD PKWY STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-6555
Practice Address - Country:US
Practice Address - Phone:256-350-9750
Practice Address - Fax:256-350-9751
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH7303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist