Provider Demographics
NPI:1508180258
Name:PENDLEY, JULIA NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:NICOLE
Last Name:PENDLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 BLOSSOM CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5394
Mailing Address - Country:US
Mailing Address - Phone:678-888-1590
Mailing Address - Fax:678-731-1590
Practice Address - Street 1:6470 GA HIGHWAY 400
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-3460
Practice Address - Country:US
Practice Address - Phone:678-888-1590
Practice Address - Fax:678-731-1590
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0096272251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108614CMedicaid