Provider Demographics
NPI:1558758565
Name:MOORE, JULIE SMITH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SMITH
Last Name:MOORE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 E COURT SQ
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-2024
Mailing Address - Country:US
Mailing Address - Phone:404-933-2101
Mailing Address - Fax:
Practice Address - Street 1:9 E COURT SQ
Practice Address - Street 2:APARTMENT E
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-2024
Practice Address - Country:US
Practice Address - Phone:404-933-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist