Provider Demographics
NPI:1437248929
Name:AMENDOLA, JULIE
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:AMENDOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E. LAMAR BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-4465
Mailing Address - Country:US
Mailing Address - Phone:817-795-6316
Mailing Address - Fax:817-795-6318
Practice Address - Street 1:1601 E LAMAR BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4465
Practice Address - Country:US
Practice Address - Phone:817-795-6316
Practice Address - Fax:817-795-6318
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXOT100122208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX653003Medicare ID - Type Unspecified