Provider Demographics
NPI:1417067471
Name:MARTIN, JULIE G (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:G
Last Name:MARTIN
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 1:99 COUNTRY WOOD LN
Mailing Address - Street 2:APT. 4
Mailing Address - City:COLLINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24078-2761
Mailing Address - Country:US
Mailing Address - Phone:276-252-2240
Mailing Address - Fax:
Practice Address - Street 1:2802 GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-8109
Practice Address - Country:US
Practice Address - Phone:276-666-1600
Practice Address - Fax:276-666-9658
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010290589Medicaid
VA7030669OtherAETNA PROVIDER NUMBER
VA00W078F01Medicare PIN