Provider Demographics
NPI:1588638282
Name:MASSEY, JULIE M (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:MASSEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:TABB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:117 OAKLAND PKWY
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-7201
Practice Address - Country:US
Practice Address - Phone:229-483-0055
Practice Address - Fax:706-494-3008
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q22702Medicare UPIN
GA65BBCPSMedicare PIN
GAP00238244Medicare PIN