Provider Demographics
NPI:1710104245
Name:ANDERSON, JULIA KATHERINE (PT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:KATHERINE
Last Name:ANDERSON
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 1:13024 BEVERLY PARK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5857
Mailing Address - Country:US
Mailing Address - Phone:425-353-8797
Mailing Address - Fax:425-353-8765
Practice Address - Street 1:13024 BEVERLY PARK RD STE 102
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5857
Practice Address - Country:US
Practice Address - Phone:425-353-8797
Practice Address - Fax:425-353-8765
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000005121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA109064OtherDEPT. OF LABOR AND INDUST