Provider Demographics
NPI:1609213115
Name:CHESTNUT, JULIE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CHESTNUT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:HATCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:128 AMES ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9739
Mailing Address - Country:US
Mailing Address - Phone:231-264-6682
Mailing Address - Fax:
Practice Address - Street 1:128 AMES ST
Practice Address - Street 2:
Practice Address - City:ELK RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49629-9739
Practice Address - Country:US
Practice Address - Phone:231-264-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist