Provider Demographics
NPI:1891996310
Name:JULES, SALLY-ANN S (PT)
Entity Type:Individual
Prefix:MRS
First Name:SALLY-ANN
Middle Name:S
Last Name:JULES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SALLY-ANN
Other - Middle Name:S
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:132 BENT TWIG LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2735
Mailing Address - Country:US
Mailing Address - Phone:240-632-2066
Mailing Address - Fax:
Practice Address - Street 1:19733 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2642
Practice Address - Country:US
Practice Address - Phone:301-540-4700
Practice Address - Fax:301-540-4721
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19710225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD66740008OtherCAREFIRST
MD90376OtherAMERIGROUP
MD292519OtherMAMSI
MD66740008OtherCAREFIRST