Provider Demographics
NPI:1588612659
Name:KNOWLES, JULIE MOYER (EDD,PT,ATC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:MOYER
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:EDD,PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LANTANA DR
Mailing Address - Street 2:LANTANA SQUARE
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-2800
Mailing Address - Fax:302-239-7500
Practice Address - Street 1:216 LANTANA DR
Practice Address - Street 2:LANTANA SQUARE
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8805
Practice Address - Country:US
Practice Address - Phone:302-239-2800
Practice Address - Fax:302-239-7500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000360225100000X
DEJ3-00000302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00B228S11Medicare ID - Type Unspecified