Provider Demographics
NPI:1689437006
Name:EHMSEN, JULIE SIMONE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:SIMONE
Last Name:EHMSEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 ARCOS WAY APT 1225
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1127
Mailing Address - Country:US
Mailing Address - Phone:903-530-1423
Mailing Address - Fax:
Practice Address - Street 1:8300 WEST FWY
Practice Address - Street 2:
Practice Address - City:WHITE SETTLEMENT
Practice Address - State:TX
Practice Address - Zip Code:76108-3453
Practice Address - Country:US
Practice Address - Phone:817-600-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1356908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist