Provider Demographics
NPI:1598088957
Name:STANEY, JULIE MARIE (ATC/LAT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MARIE
Last Name:STANEY
Suffix:
Gender:F
Credentials:ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2746 CHADDSFORD CIR
Mailing Address - Street 2:APARTMENT 200
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2699 LEE RD
Practice Address - Street 2:#100
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1753
Practice Address - Country:US
Practice Address - Phone:407-897-1363
Practice Address - Fax:407-897-1384
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 27292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22OtherATHLETIC TRAINER