Provider Demographics
NPI:1598994469
Name:ROYAL, JULIE MAYBACH (PT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:MAYBACH
Last Name:ROYAL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:MAYBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:381 STUYVESANT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2400
Mailing Address - Country:US
Mailing Address - Phone:540-270-2149
Mailing Address - Fax:540-347-4456
Practice Address - Street 1:381 STUYVESANT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2400
Practice Address - Country:US
Practice Address - Phone:540-270-2149
Practice Address - Fax:540-347-4456
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23050057332251X0800X, 2251G0304X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics