Provider Demographics
NPI:1750510970
Name:MUNSON, JULIE THERESE (PT,ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:THERESE
Last Name:MUNSON
Suffix:
Gender:F
Credentials:PT,ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23161 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1956
Mailing Address - Country:US
Mailing Address - Phone:586-779-8892
Mailing Address - Fax:586-779-2869
Practice Address - Street 1:23161 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1956
Practice Address - Country:US
Practice Address - Phone:586-779-8892
Practice Address - Fax:586-779-2869
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
236540Medicare Oscar/Certification