Provider Demographics
NPI:1679840144
Name:KLIEWER, JULIE LEE (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LEE
Last Name:KLIEWER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LEE
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 SPA RD
Mailing Address - Street 2:E
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1063
Mailing Address - Country:US
Mailing Address - Phone:409-599-4973
Mailing Address - Fax:
Practice Address - Street 1:1505 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5669
Practice Address - Country:US
Practice Address - Phone:956-383-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2083450225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant