Provider Demographics
NPI:1639413768
Name:GROATH, JULI ANN (DPT)
Entity Type:Individual
Prefix:
First Name:JULI
Middle Name:ANN
Last Name:GROATH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BOONE AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4468
Mailing Address - Country:US
Mailing Address - Phone:763-267-6654
Mailing Address - Fax:763-267-6653
Practice Address - Street 1:800 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4468
Practice Address - Country:US
Practice Address - Phone:763-267-6654
Practice Address - Fax:763-267-6653
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist