Provider Demographics
NPI:1568621217
Name:JULIAS, SAMANTHA LEIGH (ATC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:JULIAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 N PARAQUA CIR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428-6696
Mailing Address - Country:US
Mailing Address - Phone:352-613-7703
Mailing Address - Fax:
Practice Address - Street 1:365 BILL FRANCE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1301
Practice Address - Country:US
Practice Address - Phone:386-323-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 24802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer