Provider Demographics
NPI:1578711875
Name:PROCTOR, JULIE KAY
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:KAY
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MARIETTA RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9433
Mailing Address - Country:US
Mailing Address - Phone:740-772-5900
Mailing Address - Fax:740-773-3946
Practice Address - Street 1:60 MARIETTA RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9433
Practice Address - Country:US
Practice Address - Phone:740-772-5900
Practice Address - Fax:740-773-3946
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH06109225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant