Provider Demographics
NPI:1861839219
Name:DEGEYTER, JULIE A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:DEGEYTER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 W FOREST AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1483
Mailing Address - Country:US
Mailing Address - Phone:928-213-6229
Mailing Address - Fax:928-773-2126
Practice Address - Street 1:77 W FOREST AVE STE 301
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:282-136-2299
Practice Address - Fax:928-773-2126
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist