Provider Demographics
NPI:1679631485
Name:MANI, JULIE ELIZABETH (PT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ELIZABETH
Last Name:MANI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-3209
Mailing Address - Country:US
Mailing Address - Phone:512-478-5198
Mailing Address - Fax:
Practice Address - Street 1:2407 BRIDLE PATH
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3209
Practice Address - Country:US
Practice Address - Phone:512-478-5198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000659682OtherBLUE CROSS ID NUMBER