Provider Demographics
NPI:1598997355
Name:LOE, JULIE Y (MA, ECSE)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:Y
Last Name:LOE
Suffix:
Gender:F
Credentials:MA, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2585 IRONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1755
Mailing Address - Country:US
Mailing Address - Phone:805-772-6014
Mailing Address - Fax:805-772-8246
Practice Address - Street 1:524 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1913
Practice Address - Country:US
Practice Address - Phone:805-772-6014
Practice Address - Fax:805-772-8246
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3769225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant