Provider Demographics
NPI:1568486132
Name:DAVITZ, JULIE M (PT, AT,C)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:DAVITZ
Suffix:
Gender:F
Credentials:PT, AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 KENRICK PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4414
Mailing Address - Country:US
Mailing Address - Phone:314-962-8020
Mailing Address - Fax:314-962-6570
Practice Address - Street 1:78 KENRICK PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4414
Practice Address - Country:US
Practice Address - Phone:314-962-8020
Practice Address - Fax:314-962-6570
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 019922251S0007X
MOMO 001892255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer