Provider Demographics
NPI:1447743869
Name:MECHAM, JULIE ANN (MPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:MECHAM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:GIBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:600 52ND ST STE 240
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:888-488-8714
Mailing Address - Fax:262-925-5001
Practice Address - Street 1:7200 WASHINGTON AVE STE 103
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-6516
Practice Address - Country:US
Practice Address - Phone:262-583-0790
Practice Address - Fax:262-583-0768
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5649-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist