Provider Demographics
NPI:1558814152
Name:DAVIS, JULIA BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:BROOKE
Last Name:DAVIS
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 1:3019 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4407
Mailing Address - Country:US
Mailing Address - Phone:904-718-0529
Mailing Address - Fax:
Practice Address - Street 1:1564 KINGSLEY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4521
Practice Address - Country:US
Practice Address - Phone:904-644-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL31765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist