Provider Demographics
NPI:1710204789
Name:MAST, JULIE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANN
Last Name:MAST
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 1:6146 BEAUMONT SQ
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8157
Mailing Address - Country:US
Mailing Address - Phone:740-657-1616
Mailing Address - Fax:
Practice Address - Street 1:720 EAST BROAD STREEET
Practice Address - Street 2:NOVACARE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-8157
Practice Address - Country:US
Practice Address - Phone:614-224-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist