Provider Demographics
NPI:1811012446
Name:ITAMURA, JULIA LINN (DPT)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:LINN
Last Name:ITAMURA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:LINN
Other - Last Name:BURLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-1200
Mailing Address - Fax:
Practice Address - Street 1:1640 MARENGO ST
Practice Address - Street 2:#102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1036
Practice Address - Country:US
Practice Address - Phone:323-224-7070
Practice Address - Fax:323-224-7075
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT212532251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT21253AMedicare ID - Type UnspecifiedPPIN