Provider Demographics
NPI:1780647693
Name:LANDECKER, JULIE K (DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:LANDECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:K
Other - Last Name:MALCHAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:901 SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3813
Mailing Address - Country:US
Mailing Address - Phone:707-339-3423
Mailing Address - Fax:
Practice Address - Street 1:901 SPENCER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3813
Practice Address - Country:US
Practice Address - Phone:707-339-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist