Provider Demographics
NPI:1447566336
Name:VANAGS, JULIE SOPHIA (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SOPHIA
Last Name:VANAGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 GREENWAY AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3079
Mailing Address - Country:US
Mailing Address - Phone:772-567-3228
Mailing Address - Fax:
Practice Address - Street 1:7975 17TH LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-2430
Practice Address - Country:US
Practice Address - Phone:772-567-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22255225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant