Provider Demographics
NPI:1912042391
Name:TANAKA, JULIE DEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:DEEN
Last Name:TANAKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 223802
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93922
Mailing Address - Country:US
Mailing Address - Phone:831-372-0651
Mailing Address - Fax:831-372-0655
Practice Address - Street 1:700 CASS STREET #116
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-372-0651
Practice Address - Fax:831-372-0655
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27935225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist