Provider Demographics
NPI:1316377575
Name:DAVIS, JULIA (PT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:DAVIS
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 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:130 MARVIN RD SE
Practice Address - Street 2:STE 203
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6100
Practice Address - Country:US
Practice Address - Phone:360-456-3300
Practice Address - Fax:425-775-0963
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036944-1225100000X
WAPT60539770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist