Provider Demographics
NPI:1619603602
Name:KINGSBURY, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 N LOOP 1604 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2799
Mailing Address - Country:US
Mailing Address - Phone:210-590-4000
Mailing Address - Fax:
Practice Address - Street 1:307 FARLEY ST
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4325
Practice Address - Country:US
Practice Address - Phone:512-846-6960
Practice Address - Fax:512-846-6961
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist