Provider Demographics
NPI:1255495933
Name:FREY, JULIE ANN (NCMT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:FREY
Suffix:
Gender:F
Credentials:NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 WALL ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2197
Mailing Address - Country:US
Mailing Address - Phone:770-922-8187
Mailing Address - Fax:770-922-9107
Practice Address - Street 1:2365 WALL ST SE
Practice Address - Street 2:SUITE 100
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2197
Practice Address - Country:US
Practice Address - Phone:770-922-8187
Practice Address - Fax:770-922-9107
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
148615-00225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist