Provider Demographics
NPI:1649380999
Name:MANKINEN, JULIE (MSPT, OCS, FAAOMPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:MANKINEN
Suffix:
Gender:F
Credentials:MSPT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2830
Mailing Address - Country:US
Mailing Address - Phone:512-452-2667
Mailing Address - Fax:
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BUILDING 1 SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-339-1500
Practice Address - Fax:512-339-1501
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX11169032251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1116903OtherLICENSE
TX8L7628Medicare UPIN